Adherence to Guidelines for Breast Surveillance in Breast Cancer Survivors

Restricted access

Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, healthcare use, and breast imaging in the first and fifth years after surgery. Results: A total of 27,212 patients were followed for a median of 2.9 years (interquartile range, 1.8–4.6) after definitive breast cancer surgery. In year 1, 78% were screened using mammography alone, 1% using MRI alone, and 8% using both tests; 13% did not undergo either. By year 5, the proportion of the remaining cohort (n=4,790) who had no breast imaging was 19%. Older age was associated with an increased likelihood of mammography and a decreased likelihood of MRI during the first and fifth years. Black race, mastectomy, chemotherapy, and no MRI at baseline were all associated with a decreased likelihood of both types of imaging. Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes. Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.

Author contributions: Study concept: Ruddy. Study design: Ruddy, Sangaralingham, Freedman, Mougalian, Neuman, Greenberg, Jemal, Gross, Shah. Funding acquisition: Ruddy. Data analysis: Sangaralingham. Interpretation of results: Ruddy, Freedman, Mougalian, Neuman, Greenberg, Jemal, Duma, Haddad, Lemaine, Ghosh, Hieken, Hunt, Vachon, Gross, Shah. Manuscript preparation: Ruddy. Critical revision and final approval: All authors.Correspondence: Kathryn J. Ruddy, MD, MPH, Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email: Ruddy.kathryn@mayo.edu
  • 1.

    KhatcheressianJLHurleyPBantugE. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol2013;31:961965.

    • Search Google Scholar
    • Export Citation
  • 2.

    SaslowDBoetesCBurkeW. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin2007;57:7589.

    • Search Google Scholar
    • Export Citation
  • 3.

    GradisharWJAndersonBOBalassanianR. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 1.2016. Accessed December 1 2016. To view the most recent version of these guidelines visit NCCN.org.

    • Search Google Scholar
    • Export Citation
  • 4.

    LuWLJansenLPostWJ. Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis. Breast Cancer Res Treat2009;114:403412.

    • Search Google Scholar
    • Export Citation
  • 5.

    PaszatLSutradharRGrunfeldE. Outcomes of surveillance mammography after treatment of primary breast cancer: a population-based case series. Breast Cancer Res Treat2009;114:169178.

    • Search Google Scholar
    • Export Citation
  • 6.

    HoussamiNCiattoS. Mammographic surveillance in women with a personal history of breast cancer: how accurate? How effective?Breast2010;19:439445.

    • Search Google Scholar
    • Export Citation
  • 7.

    HoussamiNCiattoSMartinelliF. Early detection of second breast cancers improves prognosis in breast cancer survivors. Ann Oncol2009;20:15051510.

    • Search Google Scholar
    • Export Citation
  • 8.

    BrennanSLibermanLDershawDDMorrisE. Breast MRI screening of women with a personal history of breast cancer. AJR Am J Roentgenol2010;195:510516.

    • Search Google Scholar
    • Export Citation
  • 9.

    WeinstockCCampassiCGoloubevaO. Breast magnetic resonance imaging (MRI) surveillance in breast cancer survivors. Springerplus2015;4:459.

    • Search Google Scholar
    • Export Citation
  • 10.

    LehmanCDLeeJMDeMartiniWB. Screening MRI in women with a personal history of breast cancer. J Natl Cancer Inst2016;108:pii: djv349.

  • 11.

    KeatingNLLandrumMBGuadagnoliE. Factors related to underuse of surveillance mammography among breast cancer survivors. J Clin Oncol2006;24:8594.

    • Search Google Scholar
    • Export Citation
  • 12.

    Carcaise-EdinboroPBradleyCJDahmanB. Surveillance mammography for Medicaid/Medicare breast cancer patients. J Cancer Surviv2010;4:5966.

    • Search Google Scholar
    • Export Citation
  • 13.

    DoubeniCAFieldTSUlcickas YoodM. Patterns and predictors of mammography utilization among breast cancer survivors. Cancer2006;106:24822488.

    • Search Google Scholar
    • Export Citation
  • 14.

    BrawarskyPNevilleBAFitzmauriceGM. Use of annual mammography among older women with ductal carcinoma in situ. J Gen Intern Med2012;27:500505.

    • Search Google Scholar
    • Export Citation
  • 15.

    EtimAESchellhaseKGSparapaniRNattingerAB. Effect of model of care delivery on mammography use among elderly breast cancer survivors. Breast Cancer Res Treat2006;96:293299.

    • Search Google Scholar
    • Export Citation
  • 16.

    FieldTSDoubeniCFoxMP. Under utilization of surveillance mammography among older breast cancer survivors. J Gen Intern Med2008;23:158163.

    • Search Google Scholar
    • Export Citation
  • 17.

    SchapiraMMMcAuliffeTLNattingerAB. Underutilization of mammography in older breast cancer survivors. Med Care2000;38:281289.

  • 18.

    FreedmanRAKeatingNLPaceLE. Use of surveillance mammography among older breast cancer survivors by life expectancy. J Clin Oncol2017;35:31233130.

    • Search Google Scholar
    • Export Citation
  • 19.

    WallacePJShahNDDennenT. Optum Labs: building a novel node in the learning health care system. Health Aff (Millwood)2014;33:11871194.

    • Search Google Scholar
    • Export Citation
  • 20.

    OptumLabs. OptumLabs in Review: 2016. Available at: https://www.optumlabs.com/content/dam/optum/resources/OptumLabs-2016-Review.pdf. Accessed May 2 2016.

    • Search Google Scholar
    • Export Citation
  • 21.

    NattingerABLaudPWBajorunaiteR. An algorithm for the use of Medicare claims data to identify women with incident breast cancer. Health Serv Res2004;39(6 Pt 1):17331749.

    • Search Google Scholar
    • Export Citation
  • 22.

    GoldHTDoHT. Evaluation of three algorithms to identify incident breast cancer in Medicare claims data. Health Serv Res2007;42:20562069.

    • Search Google Scholar
    • Export Citation
  • 23.

    QuanHSundararajanVHalfonP. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care2005;43:11301139.

    • Search Google Scholar
    • Export Citation
  • 24.

    PeppercornJHorickNHouckK. Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: a natural experiment. Cancer2017;123:25062515.

    • Search Google Scholar
    • Export Citation
  • 25.

    KhanNFCarpenterLWatsonERosePW. Cancer screening and preventative care among long-term cancer survivors in the United Kingdom. Br J Cancer2010;102:10851090.

    • Search Google Scholar
    • Export Citation
  • 26.

    OnegaTCookAKirlinB. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography. Breast Cancer Res Treat2011;129:269275.

    • Search Google Scholar
    • Export Citation
  • 27.

    WirtzHSBoudreauDMGralowJR. Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors. Breast Cancer Res Treat2014;143:541550.

    • Search Google Scholar
    • Export Citation
  • 28.

    GiulianiOManciniSPulitiD. Patterns and determinants of receipt of follow-up mammography and/or clinical examination in a cohort of Italian breast cancer survivors. Breast Cancer Res Treat2016;158:543551.

    • Search Google Scholar
    • Export Citation
  • 29.

    RisendalBCSedjoRLGiulianoAR. Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers. J Cancer Surviv2016;10:96102.

    • Search Google Scholar
    • Export Citation
  • 30.

    TurnbullLBrownSHarveyI. Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet2010;375:563571.

    • Search Google Scholar
    • Export Citation
  • 31.

    ChoNHanWBoo-KyungH. Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years of younger at diagnosis and treated with breast conservation therapy. JAMA Oncol2017;3:14951502.

    • Search Google Scholar
    • Export Citation
  • 32.

    NewmanLAGriffithKAJatoiI. Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status. J Clin Oncol2006;24:13421349.

    • Search Google Scholar
    • Export Citation
  • 33.

    PierceLFowbleBSolinLJ. Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome. Cancer1992;69:28312841.

    • Search Google Scholar
    • Export Citation
  • 34.

    ConnorCSTouijerAKKrishnanLMayoMS. Local recurrence following breast conservation therapy in African-American women with invasive breast cancer. Am J Surg2000;179:2226.

    • Search Google Scholar
    • Export Citation
  • 35.

    TammemagiCM. Racial/ethnic disparities in breast and gynecologic cancer treatment and outcomes. Curr Opin Obstet Gynecol2007;19:3136.

    • Search Google Scholar
    • Export Citation
  • 36.

    FreedmanRAKeatingNLPartridgeAH. Surveillance mammography in older patients with breast cancer—can we ever stop?JAMA Oncol2017;3:402409.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 900 900 87
PDF Downloads 177 177 13
EPUB Downloads 0 0 0