Breast cancer patients are recommended to undergo annual mammography screenings after finishing their treatment, but recent data suggests that nearly one-third of these women in the U.S. are not even starting post-treatment screenings — and that access in the first year often determines whether mammograms will be offered patients in subsequent years.
The findings were presented at the 2016 Annual Clinical Congress of the American College of Surgeons, held Oct. 16–20 in Washington, D.C.
A team at the University of Wisconsin School of Medicine and Public Health, led by Dr. Caprice Greenberg, examined the use of surveillance magnetic resonance imaging (MRI) and mammography in 9,622 women who underwent surgery for Stage 2 or Stage 3 breast cancer. Data gathered came from the National Cancer Database (NCDB) for 2006 and 2007.
Researchers evaluated imaging, new cancer, cancer recurrence, and death rates over a five-year period from the time of diagnosis. In addition, they collected information regarding the reason for imaging (diagnostic assessment of a new sign or symptom of breast cancer, or follow-up breast surveillance without any signs and symptoms). Half of the women taking part in the study were 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,” Greenberg, who is also the director of the Wisconsin Surgical Outcomes Research Program (WiSOR), said in a news release. “This study is the first to look at a large, multi-institutional population of patients across all age groups.”
Results revealed that follow-up breast surveillance imaging dropped from 66 percent in the first year to 58 percent in the fourth year. Among women who did undergo follow-up breast surveillance imaging, only 10 percent received MRIs, the researchers found.
“The most striking finding is that over 30 percent of women don’t even get surveillance breast imaging in the first place,” 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.”
When the researchers looked for the factors that could be related to subsequent breast surveillance imaging, they found that age, race, stage of cancer, overall health condition, type of surgical procedure, and insurance status all influenced the follow-up care given.
“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 the study’s 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.”
When the researchers assessed the use of both MRI and mammography, they found that mammography was not influenced by the clinical setting at which women received care, but MRI use 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,” 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.”
Researchers recommended that clinicians be more assertive in making sure that breast cancer patients get the recommended follow-up imaging. “[R]ight 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,” Greenberg said. “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.”