Breast cancer survivors are not getting the recommended level of post-surgery screening, according to a study published in the May 2018 issue of the Journal of the National Comprehensive Cancer Network (JNCCN). Contrary to screening recommendations, mammography rates decline over time as women get further out from their breast cancer diagnosis; African-American women in particular were less likely to receive the recommended amount of screening.
The study was led by Kathryn Ruddy, M.D., M.P.H., a Mayo Clinic medical oncologist in Rochester, Minnesota and co-chair of the Mayo Clinic Cancer Center Survivorship Cross-disciplinary Group. Dr. Ruddy is also a member of the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology Panel for Survivorship.
“The use of regular mammograms to detect a return of breast cancer before any symptoms appear is associated with better overall survival,” said Dr. Ruddy. “Therefore, clinicians need to make sure that their patients are fully aware of the role these annual mammograms play in screening for new breast cancers as well as for local recurrences. Creating and implementing survivorship care plans with clear follow-up instructions may help ensure that more survivors adhere to recommended screening schedules.”
The researchers followed 27,212 patients for a median of 2.9 years after breast cancer surgery (excluding those who had bilateral mastectomy, for whom mammograms are not needed), with 4,790 patients remaining in the study cohort for at least 65 months.
The retrospective analysis used the OptumLabs Data Warehouse, containing claims from privately insured patients and Medicare Advantage enrollees from across the United States. One year out from surgery, they found 13 percent of the survivors had not undergone any breast imaging. The number without a mammogram within the past year rose to 19 percent by five years after surgery.
Only 50 percent of the patients who were followed for at least five years had at least one mammogram each of those five years.
The study also found that African-American breast cancer survivors were less likely than their white counterparts to receive mammograms according to the recommended schedule. This may contribute to higher mortality rates for that population, given that recurrence of cancer in the breast is considered to be a major driver for poor prognosis in African-American women. While the reasons for this disparity aren’t clear, limited access to genetic testing could be a factor.
There are new tools currently in development to help support and encourage adherence to post-treatment screening guidelines, including mobile apps and web-based programs. Further research is needed to explore how variability in reimbursements for imaging tests may impact surveillance testing.
This story is based on a May 24, 2018 news release provided by the National Comprehensive Cancer Network.