A new study in JNCCN finds that, 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.
Kathryn J. Ruddy, MD, MPH
Mayo Clinic Cancer Center
Member, NCCN Guidelines
Panel for Survivorship
FORT WASHINGTON, PA [May 24, 2018] — Breast cancer survivors are not getting the recommended level of screening, post-surgery, according to a newly-published study in JNCCN – Journal of the National Comprehensive Cancer Network. The study was led by Kathryn Ruddy, MD, MPH, Director of Cancer Survivorship for the Department of Oncology, Mayo Clinic Cancer Center. Dr. Ruddy — who is also a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Survivorship — looked at the post-surgery mammography rates for women with health insurance. While NCCN Guidelines® recommend annual mammograms for early-detection of disease recurrence; this study found that even women who remained insured were less likely to meet that standard, as they became long-term survivors.
“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% of the survivors had not undergone any breast imaging. The number without a mammogram within the past year rose to 19% by five years after surgery. Only 50% of the patients who were followed for at least five years had at least one mammogram each of those five years.
“This lack of imaging follow-up represents a missed opportunity for identifying recurrent or new breast cancers among a high-risk patient subgroup,” said Benjamin O. Anderson, MD, FACS, Professor of Surgery and Global Health Medicine at the University of Washington and Fred Hutchinson Cancer Research Center and Vice-Chair for the NCCN Guidelines Panel for Breast Cancer. “Of equal importance, this finding illustrates that our healthcare system can fail to track sizable groups of cancer patients after completion of treatment. The NCCN Guidelines for Survivorship delineate quality-of-life issues that patients must address, which together with tests like follow-up mammograms should be part of a coherent and integrated survivorship plan.”
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.
To read the entire study, visit JNCCN.org. Complimentary access to “Adherence to Guidelines for Breast Surveillance in Breast Cancer Survivors” is available until July 10, 2018.
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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.
The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
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