One-third of breast cancer patients not getting appropriate breast imaging follow-up examOctober 19, 2016
WASHINGTON, DC: An annual mammogram is recommended after treatment for breast cancer, but nearly one-third of women diagnosed with breast cancer aren't receiving this follow-up exam, according to new findings presented at the 2016 Annual Clinical Congress of the American College of Surgeons.
While previous studies on Medicare patients suggest that surveillance imaging is underutilized, the use of mammography in a broad range of women diagnosed with breast cancer is unknown, as is the role of surveillance magnetic resonance imaging (MRI).
For this study, Caprice C. Greenberg, MD, MPH, FACS, of the University of Wisconsin School of Medicine and Public Health, and colleagues assessed the receipt of surveillance breast MRI and mammography in 9,622 women who underwent a surgical procedure to treat Stage II and III breast cancer from 2006 through 2007 with data collected from the National Cancer Database (NCDB). The NCDB is jointly sponsored by the American College of Surgeons and the American Cancer Society. Dr. Greenberg is professor of surgery and Morgridge Distinguished Chair in Health Services Research, of the University of Wisconsin School of Medicine and Public Health, Madison.
The researchers assessed imaging, cancer recurrence, new cancer, and death from the time of treatment and for five years after diagnosis. Next, they collected additional data on the reason for imaging (diagnostic evaluation of a new sign or symptom or surveillance imaging in the absence of signs and symptoms). Fifty percent of the study population was under age 60.
"Most of what we know about breast imaging comes from small studies or from Medicare data, a population that is 65 years old and older," said Dr. Greenberg, who is also the Director of the Wisconsin Surgical Outcomes Research Program (WiSOR). "This study is the first to look at a large, multi-institutional population of patients across all age groups."
According to study results, annual receipt of surveillance breast imaging declined 8 percent from the first year (66 percent) to the fourth year (58 percent). Study findings also indicate that among women who received surveillance imaging, only about 10 percent received breast MRIs.
"The most striking finding is that over 30 percent of women don't even get surveillance breast imaging in the first place," Dr. Greenberg said. "For some reason, we are not plugging them into follow-up surveillance from the outset. We also see that there are some disparities in the use of mammograms after the treatment of breast cancer."
The study shows that factors associated with not receiving breast imaging include younger age, black race, public or no insurance, worse health, more advanced cancers, receipt of excision alone or mastectomy (versus lumpectomy with radiation), and lack of systemic therapy
"The critical story here is that if women start off their follow-up care receiving guideline-recommended imaging, they're likely to continue to receive that imaging over time. Women who don't receive imaging in that first follow-up year are not likely to receive recommended surveillance breast imaging longer-term," said study co-author Jessica R. Schumacher, PhD, an associate scientist at WiSOR. "The bulk of the disparity seems to occur in that first year of follow up, so it's really important to think about what we might be able to do in that timeframe to make sure women get guideline-recommended breast imaging."
In looking at the use of both MRI and mammography, the researchers found that receipt of mammography was not influenced by where a woman received her care, but MRI was.
"This finding shows that the problem is probably at the patient population level, as opposed to what we often see, which is that there is great variation in utilization of care across hospitals," Dr. Greenberg said. "MRI is a discretionary modality and not currently recommended in guidelines for routine surveillance following breast cancer treatment, but helpful and appropriate in certain patients. Therefore, it's much more vulnerable to local practice patterns, whereas mammogram is something we all know is effective and, in general, the likelihood of getting it doesn't matter where you receive your care."
Understanding why cancer survivors aren't receiving surveillance breast imaging and the consequences of this underutilization should be a high priority, the researchers note.
"We need to recognize the fact that, right now we are putting out more and more guidelines to help standardize care and to ensure patients get high quality care, but the guidelines that are already out there have been available for a long time. So I think it's important for health care practitioners to realize that it's not enough to just put information out there. Instead, we have to be more thoughtful about how we implement what we recommend into the actual care process," Dr. Greenberg said.
"FACS" designates that a surgeon is Fellow of the American College of Surgeons.
Note: The data in this press release was updatd from the published abstract and presented by Taiwo Adesoye, MD, MPH, during a Scientific Forum session at the 2016 Clinical Congress.
Research reported in this press release was fully funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CE-1304-6543). This publication was further made possible by CTSA Grant Numbers UL1 TR000135 and KL2TR000136-09 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH); the National Cancer Institute (NCI) of the NIH under award numbers U10CA031946, U10CA033601, U10CA180821, and U10CA180882 (to the Alliance for Clinical Trials in Oncology), U10CA076001 (to the American College of Surgeons Oncology Group), and U10CA025224 (to the North Central Cancer Oncology Group).
The research presented in this press release is solely the responsibility of the author(s) and does not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit http://www.facs.org
American College of Surgeons
Related Breast Cancer Articles:
A new article published by JAMA Oncology compares outcomes for combined mammography and MRI or ultrasonography screenings for new breast cancers in women who have previously undergone breast conservation surgery and radiotherapy for breast cancer initially diagnosed at 50 or younger.
A Clinical Breast Cancer study demonstrates Videssa Breast can inform better next steps after abnormal mammogram results and potentially reduce biopsies up to 67 percent.
The proportion of women in the United States undergoing surgery for early-stage breast cancer who have preventive mastectomy to remove the unaffected breast increased significantly in recent years, particularly among younger women, and varied substantially across states.
Breast cancer patients with dense breast tissue have almost a two-fold increased risk of developing disease in the contralateral breast, according to new research from The University of Texas MD Anderson Cancer.
Breast conserving therapy (BCT) is better than mastectomy for patients with some types of early breast cancer, according to results from the largest study to date, presented at ECC2017.
An annual mammogram is recommended after treatment for breast cancer, but nearly one-third of women diagnosed with breast cancer aren't receiving this follow-up exam, according to new findings presented at the 2016 Annual Clinical Congress of the American College of Surgeons.
Even though dense breast tissue is a risk factor for breast cancer, very low mammographic breast density is associated with a worse prognosis in breast cancer patients.
Young women with early breast cancer face a difficult choice about whether to opt for a mastectomy or breast conserving therapy (BCT).
In a study appearing in the April 26 issue of JAMA, Elizabeth A.
Five years after breast-conserving surgery, radiotherapy focused around the tumor bed is as good at preventing recurrence as irradiating the whole breast, with fewer side effects, researchers from the UK have found in the large IMPORT LOW trial.
Related Breast Cancer Reading:
Chicken Soup for the Soul: Hope & Healing for Your Breast Cancer Journey: Surviving and Thriving During and After Your Diagnosis and Treatment
by Dr. Julie Silver (Author)
Chicken Soup for the Soul: Hope & Healing for Your Breast Cancer Journey will encourage comfort and encourage breast cancer patients and survivors with its inspiring stories and helpful medical information.
A support group from breast cancer diagnosis through treatment to rehabilitation and recovery, this book combines inspiring Chicken Soup for the Soul stories written just for this book and accessible leading-edge medical information from Dr. Julie Silver of Harvard Medical School. Patients and survivors will find comfort, strength and hope. View Details
Dear Friend: Letters of Encouragement, Humor, and Love for Women with Breast Cancer
by Gina L Mulligan (Author)
This beautiful collection of handwritten letters offers strength, encouragement, and comfort to women living with breast cancer. Written by compassionate strangers—many of whom have gone through their own health battles—these heartfelt letters were gathered by Girls Love Mail, an organization that provides support to people diagnosed with breast cancer as seen on NBC Nightly News. Presented in an elegant package with metallic endpapers, and a ribbon marker, and brimming with warm messages of empathy, inspiration, and humor, Dear Friend delivers words of wisdom when they're needed... View Details
Let Me Get This Off My Chest: A Breast Cancer Survivor Over-Shares
by Margaret Lesh (Author)
Tamoxifen hot flashes, mastectomy, reconstruction, breast cancer etiquette, Frankenboobs, bras with special attachments—Margaret Lesh shares all in her funny, heartfelt collection of essays, anecdotes, and life lessons from the perspective of a two-time breast cancer survivor. She’ll tell you when it’s okay to play the cancer card, what you should take to the hospital, and gives suggestions on how to cope in those dark moments of the soul. With practical tips sprinkled throughout, LET ME GET THIS OFF MY CHEST explores how breast cancer changed her outlook on life, offering honest... View Details
The Breast Cancer Survival Manual, Sixth Edition: A Step-by-Step Guide for Women with Newly Diagnosed Breast Cancer
by John Link M.D. (Author), James Waisman M.D. (Author), Nancy Link R.N. (Author)
One of the most comprehensive and bestselling books on breast cancer treatment and survival, completely revised and updated
The sixth edition of Breast Cancer Survival Manual provides essential updates on treatment and care, enhancing the basic information that has made this the most trusted guide for women diagnosed with breast cancer for the past two decades. This edition includes the most current advice on:
· The new genomic classification of breast cancer and its importance in treatment planning
· Cancer gene testing, which determines if a woman will benefit... View Details
Dr. Susan Love's Breast Book (A Merloyd Lawrence Book)
by Susan M. Love (Author), Karen Lindsey (Contributor), Elizabeth Love (Contributor)
For a woman faced with a diagnosis of breast cancer, the information available today is vast, uneven, and confusing. For more than two decades, readers have relied on Dr. Susan Love's Breast Book to guide them through this frightening thicket of research and opinion to find the best possible options for their particular situations. This sixth edition explains exciting advances in targeted treatments, hormonal therapies, safer chemotherapy, and immunologic approaches as well as new forms of surgery and radiation. There is extensive guidance for the increasing number of women living for... View Details
Breast Cancer Smoothies: 100 Delicious, Research-Based Recipes for Prevention and Recovery
by Daniella Chace (Author)
The statistics are staggering. Breast cancer is the most common type of cancer among women--About 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of her lifetime. Second only to heart disease by a mere one percent, every ounce of prevention and every window of opportunity for healing is critical. In order to reduce the risk of developing this common disease, you need a targeted plan to protect yourself from common breast toxins and to strengthen your immune defenses.
In her delightful new book, Daniella breaks down the complex topic of... View Details
Heal Breast Cancer Naturally: 7 Essential Steps to Beating Breast Cancer
by Dr. Veronique Desaulniers (Author)
One out of eight women will be diagnosed with Breast Cancer. One out of 3 women will experience some form of cancer in their life time.
I was one of those statistics even though I was living a healthy lifestyle that consisted of organic foods, regular exercise, massage, Chiropractic care and colonics. How could somebody like me develop Breast Cancer?
That very question led to thousands of hours of research, study, soul-searching and prayer. It all came together as The 7 Essentials – 7 basic steps that are necessary for preventing and healing cancer, or any dis-ease for... View Details
Getting Things Off My Chest: A Survivor's Guide to Staying Fearless and Fabulous in the Face of Breast Cancer
by Melanie Young (Author)
Charge head on into the battle with breast cancer, armed with these outstanding survivors' tips on how to stay sane, focused, and in charge. Written by a breast cancer survivor with expert insights, handy checklists and helpful questions to ask your doctors, all geared toward streamlining your new life. This detailed, upbeat book helps you make informed decisions, eat and exercise to stay strong, look and feel your best, eliminate stress and boost your spirits with positive thinking and a dose of humor. Don't let your cancer control you; empower yourself and ease the transition with this... View Details
Breast Cancer Husband: How to Help Your Wife (and Yourself) during Diagnosis, Treatment and Beyond
by Marc Silver (Author)
A unique guide, like none other on the market-packed with medical information, practical tips, psychological insight, and coping strategies-to help men help the women they love through this trying time.
When Marc Silver became a breast cancer husband three years ago, he learned firsthand how frightened and helpless the breast cancer husband feels. He searched in vain for a book that would give him the information and advice he so desperately sought. Now this award-winning journalist has compiled just the kind of emotionally supportive and useful resource that he wished he had been... View Details
Beat Breast Cancer: 19 Actions to Help You Through Diagnosis, Surgery and Beyond
by M.K. Caldwell (Author)
I am a cancer survivor. This book is for those who are facing the news of cancer, or for someone who knows someone who is fighting this fight and wants to give this book to them as a gift. A diagnosis of cancer is overwhelmingly terrible. However, the outcome can be a very successful one. Surprisingly, conquering cancer can positively change your future life for the better.What? Yes. In the darkest of hours, there is a silver lining, always. I think you will find this book to be true to life. While the news is devastating, attitude and action are everything! After I cried, I ended up... View Details