Nav: Home

Breast cancer follow-up imaging varies widely, study finds

July 13, 2018

Follow-up imaging for women with non-metastatic breast cancer varies widely across the country, according to a new study led by researchers at UC San Francisco. Some patients go without the annual mammograms that experts recommend, while others with the same cancer diagnosis receive full-body scans that expose them to significant amounts of radiation and are not recommended by experts.

Researchers said they could find no patterns in the data to explain the variation in care, but they suspected that it reflected differences in the common practices adopted by particular hospitals or physician groups. Full-body scans are expensive, costing between $2,000 and $8,000, and can be burdensome for patients who have high-deductible insurance policies that expose them to annual healthcare costs of $6,000 to $8,000 a year.

"With skyrocketing medical costs, patients are having to take greater and greater responsibility for out-of-pocket expenses," said UCSF's Benjamin Franc, MD, MS, MBA, a professor in the Department of Radiology and Biomedical Imaging, the Center for Healthcare Value, and the Philip R. Lee Institute for Health Policy Studies. "These patients already have cancer, so you don't want to induce another cancer with radiation from unnecessary imaging."

The study, published Friday, July 13, 2018, in JNCCN: Journal of the National Comprehensive Cancer Network, examined data on 36,045 women aged 18 to 64 who had surgery for cancer in one breast between 2010 and 2012. To limit the group to patients with non-metastatic disease, the researchers excluded women who received chemotherapy in the first 18 months after their surgery. The data came from the Truven Health MarketScan Commercial Database and included information for all the metropolitan statistical areas (MSAs) in the country.

Guidelines from the American Society of Clinical Oncology and the National Comprehensive Cancer Network recommend that women with non-metastatic breast cancer should receive annual physical exams and mammograms, but not full-body imaging with such technologies as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), or bone scans.

The researchers looked at an 18-month period, rather than a year, to allow time for patients to have completed any radiation therapy. They found that patients were more likely to receive recommended breast imaging within 18 months of surgery if they were younger or received radiation therapy. But the next most significant predictor was the patient's MSA. The biggest predictors of whether patients received PET imaging, which is not recommended, was the type of surgery, followed by MSA.

They found that 70.8 percent of women received at least one dedicated breast image, either a mammogram or a breast MRI, both of which are recommended for these patients. But 31.7 percent had at least one high-cost imaging procedure, and 12.5 percent had at least one PET, neither of which are recommended without a specific clinical symptom.

About half of the lowest-risk patients -- those who received only surgery -- received the recommended mammography within 18 months of their initial treatment. And between 64 and 70 percent of patients who had received a mastectomy and radiation, and were presumably higher risk, received some sort of breast imaging, either mammography or breast MRI. But, depending on where they lived, between 18 and 46 percent of patients received high-cost tomographic imaging within 18 months of their surgeries.

"Age and therapy make sense as predictors of breast imaging, but it doesn't make sense that where you live makes a difference in whether you were likely to get a follow-up mammogram or high-cost imaging," Franc said. "What's actionable here is that we have these guidelines, but doctors aren't following them."
-end-
Other UCSF authors include R. Adams Dudley, MD, MBA, Timothy Copeland, MPP, Robert Thombley, Miran Park, PhD, Ben Marafino, Mitzi Dean, MHA, MS, and W. John Boscardin, PhD; they were joined by David Seidenwurm, MD, of the Sutter Medical Group; and Bhupinder Sharma, FRCP, and Stephen R.D. Johnston, MA, FRCP, PhD, of The Royal Marsden NHS Foundation Trust, UK.

About UCSF: UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, as well as UCSF Fresno, which is dedicated to improving health in the San Joaquin Valley; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals - UCSF Medical Center and UCSF Benioff Children's Hospitals in San Francisco and Oakland - as well as Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children's Physicians and the UCSF Faculty Practice. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. UCSF faculty also provide all physician care at the public Zuckerberg San Francisco General Hospital and Trauma Center, and the SF VA Medical Center. Please visit http://www.ucsf.edu/news.

Follow UCSF

ucsf.edu | Facebook.com/ucsf | YouTube.com/ucsf

University of California - San Francisco

Related Cancer Articles:

Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Cancer genomics continued: Triple negative breast cancer and cancer immunotherapy
Continuing PLOS Medicine's special issue on cancer genomics, Christos Hatzis of Yale University, New Haven, Conn., USA and colleagues describe a new subtype of triple negative breast cancer that may be more amenable to treatment than other cases of this difficult-to-treat disease.
Metabolite that promotes cancer cell transformation and colorectal cancer spread identified
Osaka University researchers revealed that the metabolite D-2-hydroxyglurate (D-2HG) promotes epithelial-mesenchymal transition of colorectal cancer cells, leading them to develop features of lower adherence to neighboring cells, increased invasiveness, and greater likelihood of metastatic spread.
UH Cancer Center researcher finds new driver of an aggressive form of brain cancer
University of Hawai'i Cancer Center researchers have identified an essential driver of tumor cell invasion in glioblastoma, the most aggressive form of brain cancer that can occur at any age.
UH Cancer Center researchers develop algorithm to find precise cancer treatments
University of Hawai'i Cancer Center researchers developed a computational algorithm to analyze 'Big Data' obtained from tumor samples to better understand and treat cancer.
New analytical technology to quantify anti-cancer drugs inside cancer cells
University of Oklahoma researchers will apply a new analytical technology that could ultimately provide a powerful tool for improved treatment of cancer patients in Oklahoma and beyond.
Radiotherapy for lung cancer patients is linked to increased risk of non-cancer deaths
Researchers have found that treating patients who have early stage non-small cell lung cancer with a type of radiotherapy called stereotactic body radiation therapy is associated with a small but increased risk of death from causes other than cancer.
Cancer expert says public health and prevention measures are key to defeating cancer
Is investment in research to develop new treatments the best approach to controlling cancer?
UI Cancer Center, Governors State to address cancer disparities in south suburbs
The University of Illinois Cancer Center and Governors State University have received a joint four-year, $1.5 million grant from the National Cancer Institute to help both institutions conduct community-based research to reduce cancer-related health disparities in Chicago's south suburbs.
Leading cancer research organizations to host international cancer immunotherapy conference
The Cancer Research Institute, the Association for Cancer Immunotherapy, the European Academy of Tumor Immunology, and the American Association for Cancer Research will join forces to sponsor the first International Cancer Immunotherapy Conference at the Sheraton New York Times Square Hotel in New York, Sept.

Related Cancer Reading:

The Emperor of All Maladies: A Biography of Cancer
by Siddhartha Mukherjee (Author)

The Cancer-Fighting Kitchen, Second Edition: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery
by Rebecca Katz (Author), Mat Edelson (Author)

The Truth about Cancer: What You Need to Know about Cancer's History, Treatment, and Prevention
by Ty M. Bollinger (Author)

F*ck Cancer: A totally inappropriate self-affirming adult coloring book (Totally Inappropriate Series) (Volume 4)
by Jen Meyers (Author)

Anticancer: A New Way of Life
by David Servan-Schreiber MD PhD (Author)

Chris Beat Cancer: A Comprehensive Plan for Healing Naturally
by Chris Wark (Author)

The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies
by Dr. Nasha Winters ND FABNO L.Ac Dipl.OM (Author), Jess Higgins Kelley MNT (Author), Kelly Turner (Foreword)

Keto for Cancer: Ketogenic Metabolic Therapy as a Targeted Nutritional Strategy
by Miriam Kalamian EdM MS CNS (Author), Thomas N. Seyfried (Foreword)

Radical Remission: Surviving Cancer Against All Odds
by Kelly A. Turner PhD (Author)

How to Starve Cancer
by Jane McLelland (Author)

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Unintended Consequences
Human innovation has transformed the way we live, often for the better. But as our technologies grow more powerful, so do their consequences. This hour, TED speakers explore technology's dark side. Guests include writer and artist James Bridle, historians Yuval Noah Harari and Edward Tenner, internet security strategist Yasmin Green, and journalist Kashmir Hill.
Now Playing: Science for the People

#499 Technology, Work and The Future (Rebroadcast)
This week, we're thinking about how rapidly advancing technology will change our future, our work, and our well-being. We speak to Richard and Daniel Susskind about their book "The Future of Professions: How Technology Will Transform the Work of Human Experts" about the impacts technology may have on professional work. And Nicholas Agar comes on to talk about his book "The Sceptical Optimist" and the ways new technologies will affect our perceptions and well-being.