Breast Cancer Survivors Less Likely To Get Annual Screening Following Treatment

Although about six of every seven breast cancer survivors undergo a mammogram in their first year of follow-up, they are less likely to undergo mammography as they become long-term survivors, even in the absence of any change in insurance status, according to a Mayo Clinic study funded by AHRQ. Using administrative claims data from 2005 to 2015, more than 27,000 women with private insurance or Medicare Advantage were followed for an average 2.9 years following breast surgery. The study calculated the proportion of patients who had a mammogram, an MRI, both or neither screening. In the first year after treatment, 78 percent of survivors were screened by mammogram alone, 1 percent by MRI alone, 8 percent by both tests and 13 percent by neither. By the fifth year, 19 percent of survivors had no breast imaging. Researchers concluded that additional study into factors associated with imaging in breast cancer survivors—such as race, comorbidity, geography and age—may help improve adherence to survivorship care guidelines. Access the abstract of the article, published in the Journal of the National Comprehensive Cancer Network.

2018 May;16(5):526-534. doi: 10.6004/jnccn.2018.7001.

Adherence to Guidelines for Breast Surveillance in Breast Cancer Survivors.

Ruddy KJ1, Sangaralingham L1, Freedman RA1, Mougalian S1, Neuman H1, Greenberg C1, Jemal A1, Duma N1, Haddad TC1, Lemaine V1, Ghosh K1, Hieken TJ1, Hunt K1, Vachon C1, Gross C1, Shah ND1,1,1.

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Abstract

Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, healthcare use, and breast imaging in the first and fifth years after surgery. Results: A total of 27,212 patients were followed for a median of 2.9 years (interquartile range, 1.8-4.6) after definitive breast cancer surgery. In year 1, 78% were screened using mammography alone, 1% using MRI alone, and 8% using both tests; 13% did not undergo either. By year 5, the proportion of the remaining cohort (n=4,790) who had no breast imaging was 19%. Older age was associated with an increased likelihood of mammography and a decreased likelihood of MRI during the first and fifth years. Black race, mastectomy, chemotherapy, and no MRI at baseline were all associated with a decreased likelihood of both types of imaging. Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes. Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.