Breast Cancer Survivors Not Receiving Follow-Up Exams

A recent study found that as many as one-third of women diagnosed with breast cancer are not receiving follow-up mammograms.

Prior research shows that the use of imaging in Medicare patients is underutilized, but mammogram and magnetic resonance imagining (MRI) utilization in a broader population of women was previously unknown.

“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 researcher Caprice C. Greenberg, MD, MPH, FACS. “This study is the first to look at a large, multi-institutional population of patients across all age groups.”

The current study, which was presented at the 2016 Clinical Congress of the American College of Surgeons, included breast MRI and mammography occurrence in 9622 women who underwent surgical treatment of stage 2 or 3 breast cancer during 2006 and 2007. Investigators gathered data from the national cancer database.

They examined imaging, recurrence, new cancer, and death from the initiation of treatment until 5 years after diagnosis. The investigators also collected data about the reason for imaging, such as symptom evaluation or surveillance imaging.

They discovered that the administration of surveillance imaging decreased from 66% in 2006 to 58% in 2007, with only 10% of those undergoing surveillance imaging also receiving breast MRIs.

“The most striking finding is that over 30% 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.”

Several factors were linked to not receiving the proper imaging, which included young age, race, public or no health insurance, poor health, advanced cancer, surgical intervention only (compared with surgery and radiation), and no systemic therapy, according to the study.

“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. “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.”

The investigators also found that mammogram use was not influenced by where the patient received the 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,” 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.”

Better understanding about why breast cancer survivors are not receiving the recommended follow up is critical in increasing utilization, according to the study.

“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,” Dr. Greenberg concluded. “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.”