Breast cancer survivors who have residual breast tissue are recommended to undergo mammographic surveillance annually. ASCO, the American Cancer Society (ACS), and NCCN recommend annual mammograms beginning at 1 year after the mammogram that led to the cancer diagnosis, and at least 6 months after the completion of postlumpectomy radiation.1–3 It has been shown that mammographic detection of asymptomatic recurrences is associated with earlier disease stage and increased overall survival.4–7
In contrast to the consistent recommendation for mammography of residual breast tissue in this setting, ACS, ASCO, and NCCN state that there is insufficient evidence to recommend for or against MRI for routine breast cancer surveillance.1–3 According to guidelines, breast MRI should never be used instead of mammography, and only in addition to mammograms for those with a >20% lifetime breast cancer risk based on very strong family history, with a known cancer predisposition syndrome, or who had radiation therapy to the chest between ages 10 and 30 years. Evidence to support MRIs among breast cancer survivors is limited,8,9 but a recent case series study suggested that MRI may be more specific in breast cancer survivors than in women with only genetic risk or a strong family history.10
Real-world adherence to breast imaging guidelines among mixed-age women with breast cancer has been understudied in the United States. In women aged >65 years diagnosed with stage I–II breast cancer between 1992 and 1999, a SEER-Medicare analysis revealed that only 78% underwent mammography during months 7 to 18 after diagnosis, and only 57% had mammography yearly within 3 years.11 Patients who continued to see oncology specialists and who were younger, white (vs black), and living in certain regions were more likely to undergo mammography. Other studies have shown similar findings in older patients diagnosed more than a decade ago, generally with only 3 to 4 years of follow-up.12–17 A recent study using survey responses from 1,040 breast cancer survivors aged >65 years in the National Health Interview Survey found that 78.9% self-reported receipt of a mammogram in the prior 12 months, including only 86% of the 365 who had a life expectancy >10 years.18 We aimed to expand on this work by assessing rates and predictors of breast MRI and mammography in a modern cohort of mixed-age breast cancer survivors, and investigating how rates of imaging changed as time passed after diagnosis.
Dr. Mougalian has disclosed that she has stock or other ownership interest with Gilead Services Inc. and Roche Holdings Ltd., has a consulting or advisory role with Eisai Pharmaceuticals and Hylapharm LLC, and has received research funding with NCCN/Pfizer. Dr. Lemaine has disclosed that she has stock or other ownership interest with Exact Sciences, has received honoraria from ACEL RX, has a consulting or advisory role with ACESE RX and Lifecell, has received research funding from Allergan, and has had travel expenses associated with activities listed herein paid by Bonti, ACEL RX, and Lifecell. Dr. Vachon has disclosed that she has a leadership role with and has received research funding from Grail Inc. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
Dr. Ruddy and Ms. Sangaralingham were supported by an NCCN Young Investigator Award (PI: Ruddy).
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