Many breast cancer survivors do not receive recommended mammograms
A considerable number of insured breast cancer survivors do not undergo recommended annual mammograms for breast cancer surveillance, according to study results published in Journal of the National Comprehensive Cancer Network.
“The use of regular mammograms to detect a return of breast cancer before any symptoms appear is associated with better overall survival,” Kathryn J. Ruddy, MD, MPH, director of cancer survivorship in the department of oncology at Mayo Clinic Cancer Center in Rochester, Minn., said in a press release. “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.”
Ruddy and colleagues used the OptumLabs Data Warehouse — a claims database that includes privately insured patients and Medicare Advantage enrollees across the United States — to assess mammography rates among 27,212 women who underwent breast cancer surgery.
Approximately 5.7% (n = 4,790) of the women remained on study for at least 65 months.
Results showed 14% of breast cancer survivors did not receive a mammogram within 1 year of surgery.
At 5 years after surgery, 19% of women had not received in a mammogram in the previous 12 months. Only half of the women analyzed received at least one mammogram each year in the initial 5-year period after surgery.
“Creating and implementing survivorship care plans with clear follow-up instructions may help ensure that more survivors adhere to recommended screening schedules,” Ruddy said.
HemOnc Today spoke with Ruddy about the study, the importance of surveillance mammography for this patient population, and what members of the clinical community can do to increase screening rates among breast cancer survivors.
Question: How did this study come about?
Answer: We applied for and received funding from a National Comprehensive Cancer Network Young Investigator Award to assess patterns of care among women treated with curative intent for breast cancer. Adherence to guidelines for mammography in patients with residual breast tissue served as one of our primary endpoints.
Q: How did you conduct the study?
A: We used administrative claims data from OptumLabs to identify a cohort of more than 27,000 women treated with lumpectomy or unilateral mastectomy for breast cancer. We assessed what types of breast imaging they had during the subsequent years after surgery.
Q: What did you find?
A: We found that 14% of these breast cancer survivors did not have a mammogram during the first year of follow-up, and this proportion increased over subsequent years. We additionally found that younger age and black race appeared associated with a lower likelihood of mammography in this cohort.
Q: What are some of the possible explanations for why this is happening?
A: More research is needed to investigate reasons that some women do not undergo annual mammography after breast cancer. I think a variety of factors may contribute. They include: busy lives and competing commitments, such as caring for children or aging parents, employment, etc.; systems issues, such as barriers to scheduling a convenient time; and distress associated with screening for recurrence.
Q: Can you explain the importance of mammography for this patient population?
A: Mammography is important to detect local recurrences and new breast cancers. Missed mammograms may allow cancers to grow larger and spread further before they are diagnosed, reducing the chance that a local recurrence or new cancer can be cured.
Q: What are the implications of your results?
A: There is an opportunity to improve rates of mammography after curative-intent treatment for breast cancer, potentially detecting more recurrences and new cancers before they become symptomatic. This could possibly augment the improved outcomes we have seen among patients with breast cancer in recent years thanks to treatment advances.
Q: What can members of the clinical community do to improve screening rates among breast cancer survivors?
A: Survivorship care plans are given to patients at the completion of their active cancer therapy that explain recommendations for future care. These include visit schedules and imaging tests. These documents provide an opportunity to emphasize the importance of annual mammography for breast cancer survivors with residual breast tissue. I also am hopeful that mobile application and web-based tools that are in development will help remind patients and providers when breast imaging is needed. – by Jennifer Southall
Ruddy KJ, et al. J Natl Compr Canc Netw. 2018;doi:10.6004/jnccn.2018.7001.
For more information:
Kathryn J. Ruddy, MD , MPH , can be reached at Division of Medical Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905; email: firstname.lastname@example.org.
Disclosure: Ruddy reports no relevant financial disclosures.