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Autier P, Jørgensen KJ, Smans M, Støvring H. Effect of screening mammography on the risk of breast cancer deaths and of all-cause deaths: a systematic review with meta-analysis of cohort studies. J Clin Epidemiol 2024; 172:111426. [PMID: 38878837 DOI: 10.1016/j.jclinepi.2024.111426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Observational cohort studies are used to evaluate the effectiveness of screening mammography in women offered screening. Because screening mammography has no effect on causes of death other than breast cancer (BC), cohort studies should show reductions in the risk of BC death substantially greater than possible reductions in the risk of all-cause death. We assessed the risk of BC deaths and of all-cause (or of nonBC) deaths associated with screening mammography attendance reported in cohort studies. STUDY DESIGN AND SETTING Cohort studies published from 2002 to 2022 on women invited to screening mammography were searched in PubMed, Web of Sciences, Scopus, and in review articles. Random effect meta-analyses were performed using relative risks (RRs) of death between women who attended screening compared to women who did not attend screening. RESULTS Eighteen cohort studies were identified, nine that reported RRs of BC deaths only, five that reported RRs of all-cause deaths only, and four that reported RRs for both BC deaths and all-cause deaths. The latter four cohort studies reported 12-76 times more all-cause deaths than BC deaths. The random-effect summary of RR for BC mortality in screening attendees vs nonattendees was 0.55 (95% CI: 0.50-0.60) in 13 cohort studies. The summary of RR for all-cause mortality was 0.54 (0.50-0.58) in 10 cohort studies. In the four cohort studies that evaluated both outcomes, the summary of RRs were 0.63 (0.43-0.83) for BC mortality and of 0.54 (0.44-0.64) for all-cause mortality. CONCLUSION The similar relative reductions in breast- and all-cause (or nonBC) mortality indicates that screening mammography attendance is an indicator of characteristics associated with a lower risk of dying from any cause, including from BC, which observational studies have falsely interpreted as a screening effect.
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Affiliation(s)
- Philippe Autier
- International Prevention Research Institute (iPRI), Lyon, France.
| | | | - Michel Smans
- International Prevention Research Institute (iPRI), Lyon, France
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Luther AZ, Singh K, Ji C, Agrawal A. When to stop? Mammographic surveillance in breast cancer survivors aged 70 years and older. Clin Radiol 2022; 77:650-654. [PMID: 35659770 DOI: 10.1016/j.crad.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/07/2022] [Indexed: 11/20/2022]
Abstract
AIM To assess the rates of breast cancer detected in postoperative surveillance mammograms in women >70 Years and overall mortality in this age group. MATERIALS AND METHODS Four hundred and ninety-eight patients were identified retrospectively from a database from a single large UK hospital. Patients were included in the study if they were female, aged >70 years at diagnosis of either invasive breast cancer or ductal carcinoma in situ (DCIS), had surgical treatment between 1 January 2010 and 31 December 2014, and no previous diagnosis of breast cancer. Statistical analysis was performed using Excel, using the X2 test, with p ≤ 0.05 considered statistically significant. RESULTS The mean age of women included in this study was 77 years. The mean number of postoperative surveillance mammograms performed per patient was 4.2. In the 5-year follow-up, there was a local recurrence rate of 1.9% (n=6) and a contralateral breast cancer rate of 1% (n=6). The 5-year overall mortality rate was 17.7% (n=88), and the 5-year breast cancer-specific mortality rate was 7.2% (n=36). CONCLUSION This study demonstrated low local recurrence and contralateral breast cancer rates during the 5-year follow-up period. Clear discussions therefore need to be held with older patients about the value of postoperative mammographic surveillance. Further research is required regarding patient opinion and experience to help develop more consistent guidelines.
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Affiliation(s)
- A Z Luther
- Breast Unit, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK.
| | - K Singh
- Breast Unit, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK
| | - C Ji
- Breast Unit, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK
| | - A Agrawal
- Breast Unit, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK
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3
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Galjart B, Höppener DJ, Aerts JGJV, Bangma CH, Verhoef C, Grünhagen DJ. Follow-up strategy and survival for five common cancers: A meta-analysis. Eur J Cancer 2022; 174:185-199. [PMID: 36037595 DOI: 10.1016/j.ejca.2022.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This meta-analysis aimed to evaluate the effectiveness of intensive follow-up after curative intent treatment for five common solid tumours, in terms of survival and treatment of recurrences. METHODS A systematic literature search was conducted, identifying comparative studies on follow-up for colorectal, lung, breast, upper gastro-intestinal and prostate cancer. Outcomes of interest were overall survival (OS), cancer specific survival (CSS), and treatment of recurrences. Random effects meta-analyses were conducted, with particular focus on studies at low risk of bias. RESULTS Fourteen out of 63 studies were considered to be at low risk of bias (8 colorectal, 4 breast, 0 lung, 1 upper gastro-intestinal, 1 prostate). These studies showed no significant impact of intensive follow-up on OS (hazard ratio, 95% confidence interval) for colorectal (0.99; 0.92-1.06), breast 1.06 (0.92-1.23), upper gastro-intestinal (0.78; 0.51-1.19) and prostate cancer (1.00; 0.86-1.16). No impact on CSS (hazard ratio, 95% confidence interval) was found for colorectal cancer (0.94; 0.77-1.16). CSS was not reported for other cancer types. Intensive follow-up increased the rate of curative treatment (relative risk; 95% confidence interval) for colorectal cancer recurrences (1.30; 1.05-1.61), but not for upper gastro-intestinal cancer recurrences (0.92; 0.47-1.81). For the other cancer types, no data on treatment of recurrences was available in low risk studies. CONCLUSION For colorectal and breast cancer, high quality studies do not suggest an impact of intensive follow-up strategies on survival. Colorectal cancer recurrences are more often treated locally after intensive follow-up. For other cancer types evaluated, limited high quality research on follow-up is available.
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Affiliation(s)
- Boris Galjart
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Diederik J Höppener
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christiaan H Bangma
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
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Karam D, Vierkant RA, Ehlers S, Freedman RA, Austin J, Khanani S, Larson NL, Loprinzi CL, Couch F, Olson JE, Ruddy KJ. Surveillance mammography in older breast cancer survivors: Current practice patterns and patient perceptions. J Geriatr Oncol 2022; 13:1038-1042. [PMID: 35853817 DOI: 10.1016/j.jgo.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/31/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although the benefits of surveillance mammography for older breast cancer survivors have not been quantified prospectively, it is unlikely that mammography provides substantial benefit (and possible that mammography is harmful) to women with limited life expectancy and a low risk for in-breast cancer events. MATERIALS AND METHODS We identified 1268 women aged 77 and older with a history of Stage I-III breast cancer, who did not undergo bilateral mastectomy, were diagnosed with cancer at least three years prior to study entry, and who had consented to be surveyed as part of the Mayo Clinic Breast Disease Registry. We mailed them a one-time survey asking about their experiences with surveillance mammography. Women with metastatic disease were excluded. The primary endpoint was whether or not women reported at least one mammogram since breast cancer surgery. RESULTS Eight hundred forty-six of 1268 (67%) returned the survey, 734 of whom were eligible for analysis. The median age at the time of survey was 82, and the median time since cancer diagnosis was 12 years. Ninety-three percent reported having had at least one mammogram since their initial breast cancer surgery. Seventy-nine percent reported that they had surveillance mammography annually over the prior three years, including 76% of the 491 aged 80+ and 64% of the 189 aged 85 + . DISCUSSION Most older breast cancer survivors who have residual breast tissue are undergoing annual mammograms. Additional educational materials may be beneficial for patients and clinicians to better individualize plans for surveillance mammography in older breast cancer survivors.
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Affiliation(s)
- Dhauna Karam
- Department of Community Internal Medicine, Mayo Clinic Health System at Austin and Albert Lea, Albert Lea, MN 56007, USA.
| | - Robert A Vierkant
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN 55905, USA
| | - Shawna Ehlers
- Division of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rachel A Freedman
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jessica Austin
- Division of Epidemiology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Sadia Khanani
- Division of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nicole L Larson
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Fergus Couch
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Janet E Olson
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Nguyen DL, Oluyemi E, Myers KS, Panigrahi B, Mullen LA, Ambinder EB. Disparities Associated With Patient Adherence of Post-Breast-Conserving Surgery Surveillance Imaging Protocols. J Am Coll Radiol 2021; 18:1540-1546. [PMID: 34364841 DOI: 10.1016/j.jacr.2021.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/12/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Currently, national and international breast imaging practices utilize variable postsurgical surveillance protocols without uniform recommendations. Due to the innate differences between screening versus diagnostic mammography from scheduling flexibility to out-of-pocket costs, this creates the opportunity for lapses in patient adherence, which has the potential to impact clinical outcomes. The purpose of this study is to evaluate the relationship between sociodemographic factors and postsurgical surveillance imaging protocols on patient adherence rates. METHODS This retrospective study reviewed 3 years of surveillance imaging for all patients having breast-conserving surgery at our institution from January 2011 to December 2016. Follow-up adherence was defined as returning for all of the first 3 years of annual follow-up after breast-conserving surgery (institutional surveillance protocol). Associations between adherence to surveillance imaging and patient sociodemographic characteristics were evaluated using univariate and multivariate logistic regression. RESULTS The study included 1,082 patients after breast surgery, 715 of whom adhered completely to the first 3 years of annual follow-up (66.1%). Black women were 1.36 times less likely to follow up annually compared with White women (95% confidence interval 1.02-1.80). Similarly, patients with Medicare were 1.84 times less likely to follow up annually compared with patients with private insurance (95% confidence interval 1.34-2.51). Women with benign breast disease after breast-conserving surgery were significantly less likely to adhere to annual surveillance than women with breast cancer. CONCLUSION Sociodemographic disparities exist as barriers for annual mammography surveillance in patients after breast-conserving surgery.
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Taher W, Benson J, Leinster S. The effectiveness of mammography surveillance after treatment of primary breast cancer: A single centre retrospective cohort study. Ann Med Surg (Lond) 2021; 65:102272. [PMID: 33912343 PMCID: PMC8066407 DOI: 10.1016/j.amsu.2021.102272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There is a little evidence that routine follow-up of patients treated for early breast cancer (BC) to detect ibsilateral breast tumour recurrence (IBTR), or contralateral breast cancer (CBC), is either effective or offers any mortality benefits. We report our experience of following patients with early BC for recurrences and new primaries in order to determine the role of mammogram surveillance. METHODS Single centre, retrospective primary observational study was designed. Patients who had BC during year 2001-2006 were included and followed for a minimum of ten years. Patients were divided based on the modalities of detecting BC in to screen detected group and clinically detected one i.e. symptomatic BC. These two groups were compared. RESULTS Total number of patients considered for analysis was 2530 (screen detected BC - 703 patients and symptomatic BC - 1827 patients). The rate of recurrence including regional and distant metastasis in screen detected BC group was 8% (57/703) and 2% (43/1827) in symptomatic one. However, the prevalence of IBTR/CBC in the whole cohort was 2% (62/2530). Mammography surveillance identified 60% (37/62) of patients who had IBTRs/CBCs.Mammography surveillance detected 85% (29/34) of all IBTRs/CBCs in the screen detected BC group. In contrast, it picked up only 29% (8/28) in the other group (Chi squared 20.5 p < 0.005). CONCLUSIONS Mammography surveillance is efficient for the screen detected BC group but not for the symptomatic one. Hence, it is worth suggesting different follow-up strategies for both groups. Further studies are therefore recommended.
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Affiliation(s)
- Wafa Taher
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - John Benson
- School of Medicine, Anglia Ruskin School of Medicine, Chelmsford, Cambridge, UK
| | - Samuel Leinster
- Norwich Medical School, University of East Anglia. Norwich Research Park, Norwich, NR4 7TJ, UK
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Abstract
Safety of pregnancy occurring after breast cancer treatment has been studied largely, but it is still debatable. These studies have generally showed that overall and disease-free survival in breast cancer survivors with subsequent pregnancy is not less than those without future pregnancy . Also, breast cancer survivors treated with chemotherapy , radiation therapy, or both had no increased risk of congenital anomalies, single gene disorders, or chromosomal syndromes in their offspring. However, it appears that the incidence of preterm labor, low birth weight, and fetal anomalies is higher in these cases.These issues as well as safe time interval from breast cancer treatment to pregnancy , safe contraceptive method after breast cancer, counseling about pregnancy in survivors, and how to follow up the patient for breast cancer recurrence during pregnancy are discussed in this chapter.
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Sella T, Dowton AA, Meyer ME, Ruddy KJ, Yeh ED, Barry WT, Partridge AH. The utility of magnetic resonance imaging in early-stage breast cancer survivors-An institutional experience and literature review. Breast J 2020; 26:1673-1679. [PMID: 32754998 DOI: 10.1111/tbj.13997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 07/14/2020] [Indexed: 11/27/2022]
Abstract
The role of breast magnetic resonance imaging (MRI) in the screening of breast cancer survivors with remaining breast tissue is not well studied. We sought to evaluate the outcomes of screening breast MRI in a cohort of breast cancer survivors. A population of patients with history of stage I-IIIa breast cancer and ≥1 MRI a year or later from diagnosis between 2006-2008 were identified using the National Comprehensive Cancer Network data base from two large Boston-area cancer centers. Patient and disease characteristics were obtained from the data base, and medical records were reviewed to identify the index MRI (first eligible), indications, and two-year outcomes. Overall, 647 patients had breast MRI scans during the study period including 342 eligible patients whose index MRIs were done for breast screening purposes. 47/342 (13.7%) were abnormal, and 3.8% (13/342) underwent biopsy, resulting in the detection of 3 cases of locoregional recurrence or new primary breast cancer (0.9%, 95% CI = 0.2%-2.5%). Of 295 patients with a normal index screening MRI, 12 had a breast cancer recurrence diagnosed within 2 years (4.1% 95%CI = 2.1%-7.0%), and 5 of these recurrences were limited to MRI-screened breast tissue. No statistically significant difference in the rate of 2-year locoregional or distant recurrence was observed between patients with an abnormal screening MRI and those with a normal scan. Adjunct single breast MRI surveillance in a general population of breast cancer survivors one year after diagnosis detected few recurrences, and its effect on short-term outcomes was unclear.
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Affiliation(s)
- Tal Sella
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Anne A Dowton
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meghan E Meyer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kathryn J Ruddy
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eren D Yeh
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William T Barry
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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Zhang D, Advani S, Zhu Z, Dang L, Walter LC, Braithwaite D. Mammography use in relation to comorbidities and functional limitations among older breast cancer survivors. J Cancer Surviv 2020; 15:119-126. [PMID: 32720225 DOI: 10.1007/s11764-020-00917-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We sought to examine associations of mammography utilization with comorbidities and functional limitations in older breast cancer survivors. METHODS Female breast cancer survivors (N = 1064) identified in the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) who were aged ≥ 65 years were included for this study. Mammography use, major comorbidities (diabetes mellitus, myocardial infarction, coronary heart disease, stroke, chronic obstructive pulmonary disease, arthritis, chronic kidney disease, depression, and malignancy other than breast cancer), functional limitations (impairment of vision, audition, cognition, and mobility), and other covariates were measured by self-report. We used multivariable logistic regression models to calculate adjusted odds ratios (aOR) of comorbidities and functional limitations. Subgroup analyses were conducted by age (65-74 vs. ≥ 75 years) and survival time (< 10 vs. ≥ 10 years), and interactions were examined by Wald tests. RESULTS Of the 1064 respondents, 841 (79.0%) had comorbidities, 418 (39.3%) had functional limitations, and 744 (69.9%) underwent mammography last year. Overall, the mean age was 73.8 years (SD = 5.1 years) and 91.4% were white. The multivariable model identified inverse associations with mammography use for functional limitations (≥ 2 vs. 0: aOR = 0.61, 95% CI = 0.39-0.95, p-trend = 0.09) but not comorbidities (≥ 2 vs. 0: aOR = 0.91, 95% CI = 0.61-1.35, p-trend = 0.62). The Wald test did not find any significant interaction. CONCLUSIONS A higher burden of functional limitations, not comorbidities, is associated with a lower rate of mammography use among older breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Interventions are needed to individualize surveillance mammography among older breast cancer survivors based on their health status.
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Affiliation(s)
- Dongyu Zhang
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Shailesh Advani
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.,Social Behavioral Research Branch, National Institute of Health, National Human Genome Research Institute, Bethesda, MD, USA
| | - Zhikai Zhu
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.,Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Le Dang
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.,National Cancer Center/National Clinical Research Center for Cancer /Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College (PUMC), Beijing, China
| | - Louise C Walter
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA.,Department of Medicine, Division of Geriatrics, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Dejana Braithwaite
- Department of Oncology, Georgetown University School of Medicine, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
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Buist DSM, Ichikawa L, Wernli KJ, Lee CI, Henderson LM, Kerlikowske K, Bowles EJA, Miglioretti DL, Specht J, Rauscher GH, Sprague BL, Onega T, Lee JM. Facility Variability in Examination Indication Among Women With Prior Breast Cancer: Implications and the Need for Standardization. J Am Coll Radiol 2020; 17:755-764. [PMID: 32004483 PMCID: PMC7275918 DOI: 10.1016/j.jacr.2019.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We sought to identify and characterize examinations in women with a personal history of breast cancer likely performed for asymptomatic surveillance. METHODS We included surveillance mammograms (1997-2017) in asymptomatic women with a personal history of breast cancer diagnosed at age ≥18 years (1996-2016) from 103 Breast Cancer Surveillance Consortium facilities. We examined facility-level variability in examination indication. We modeled the relative risk (RR) and 95% confidence intervals (CIs) at the examination level of a (1) nonscreening indication and (2) surveillance interval ≤9 months using Poisson regression with fixed effects for facility, stage, diagnosis age, surgery, examination year, and time since diagnosis. RESULTS Among 244,855 surveillance mammograms, 69.5% were coded with a screening indication, 12.7% short-interval follow-up, and 15.3% as evaluation of a breast problem. Within a facility, the proportion of examinations with a screening indication ranged from 6% to 100% (median 86%, interquartile range 79%-92%). Facilities varied the most for examinations in the first 5 years after diagnosis, with 39.4% of surveillance mammograms having a nonscreening indication. Within a facility, breast conserving surgery compared with mastectomy (RR = 1.64; 95% CI = 1.60-1.68) and less time since diagnosis (1 year versus 5 years; RR = 1.69; 95% CI = 1.66-1.72; 3 years versus 5 years = 1.20; 95% CI = 1.18-1.23) were strongly associated with a nonscreening indication with similar results for ≤9-month surveillance interval. Screening indication and >9-month surveillance intervals were more common in more recent years. CONCLUSION Variability in surveillance indications across facilities in the United States supports including indications beyond screening in studies evaluating surveillance mammography effectiveness and demonstrates the need for standardization.
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Affiliation(s)
- Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, California
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; University of California, Davis, Department of Public Health Sciences, School of Medicine, Davis, California
| | - Jennifer Specht
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Garth H Rauscher
- University of Illinois at Chicago School of Public Health, Chicago, Illinois
| | - Brian L Sprague
- University of Vermont College of Medicine, Department of Surgery, Burlington, Vermont
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice and Department of Biomedical Data Science, Department of Medicine, and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
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11
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Surveillance for second breast cancer events in women with a personal history of breast cancer using breast MRI: a systematic review and meta-analysis. Breast Cancer Res Treat 2020; 181:255-268. [PMID: 32303988 DOI: 10.1007/s10549-020-05637-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Women with personal history of breast cancer (PHBC) are currently recommended to receive annual mammography for surveillance of breast cancer recurrence or new primary. However, given issues in accuracy with mammography, there is a need for evolving evidence-based surveillance recommendations with supplemental imaging. In this systematic review, we compiled and compared existing studies that describe the test performance of surveillance breast MRI among women with PHBC. METHODS We searched PubMed and EMBASE using MeSH terms for studies (2000-2019) that described the diagnostic characteristics of breast MRI in women with PHBC. Search results were reviewed and included based on PICOTS criteria; quality of included articles was assessed using QUADAS-2. Meta-analysis of single proportions was conducted for diagnostic characteristics of breast MRI, including tests of heterogeneity. RESULTS Our review included 11 articles in which unique cohorts were studied, comprised of a total of 8338 women with PHBC and 12,335 breast MRI done for the purpose of surveillance. We predict intervals (PI) for cancer detection rate per 1000 examinations (PI 9-15; I2 = 10%), recall rate (PI 5-31%; I2 = 97%), sensitivity (PI 58-95%; I2 = 47%), specificity (PI 76-97%; I2 = 97%), and PPV3 (PI 16-40%; I2 = 44%). CONCLUSIONS Studies addressing performance of breast MRI are variable and limited in population-based studies. The summary of evidence to date is insufficient to recommend for or against use of breast MRI for surveillance among women with PHBC.
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12
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Hwong A, Wang K, Bent S, Mangurian C. Breast Cancer Screening in Women With Schizophrenia: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:263-268. [PMID: 31722645 PMCID: PMC7323869 DOI: 10.1176/appi.ps.201900318] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Women with schizophrenia appear to receive breast cancer diagnoses at later stages of the disease compared with the general population. To study this disparity, this report reviewed and quantified the differences in rates of mammography screening for women with schizophrenia and other psychotic disorders compared with the general population. METHODS A systematic literature search was conducted in PubMed, Embase, Web of Science, and PsycINFO databases. Each database was searched from inception to September 14, 2018. The search strategy included search terms for breast cancer, mammography, schizophrenia, and psychosis. Two reviewers independently screened and evaluated eligible studies. The main outcome measure was the rate of mammography screening among women with schizophrenia and psychotic disorders versus a comparable population of women without these diagnoses. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for abstracting data, and the Newcastle-Ottawa Scale was used for assessing data quality. A meta-analysis with a random-effects model was performed. RESULTS From a total of 304 abstracts reviewed, 11 studies met the inclusion criteria, representing 25,447 women with diagnoses of schizophrenia or psychosis across four countries. The meta-analysis showed that women with schizophrenia were less likely than women without schizophrenia to receive mammography screening (pooled OR=0.50, 95% confidence interval=0.38-0.64, p<0.001). In subgroup analysis, this association was not significantly affected by quality of the study. CONCLUSIONS Women with schizophrenia and other psychotic disorders were about half as likely as the general population to receive mammography screening. Further research is needed to determine causes of this disparity.
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Affiliation(s)
- Alison Hwong
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
| | - Kara Wang
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
| | - Stephen Bent
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco (UCSF), and UCSF Weill Institute for Neurosciences, San Francisco (Hwong, Mangurian); UCSF School of Medicine, San Francisco (Wang); Department of Medicine, UCSF (Bent)
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13
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Urano M, Nishikawa H, Goto T, Shiraki N, Matsuo M, Denewar FA, Kondo N, Toyama T, Shibamoto Y. Digital Mammographic Features of Breast Cancer Recurrences and Benign Lesions Mimicking Malignancy Following Breast-Conserving Surgery and Radiation Therapy. Kurume Med J 2020; 65:113-121. [PMID: 31723078 DOI: 10.2739/kurumemedj.ms654005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mammography after breast-conserving surgery and radiation therapy is an important tool for followup. Early diagnosis of local recurrence enables prompt treatment decisions, which may affect patient prognosis. For complicated post-treatment changes, radiologists sometimes have difficulties in interpreting follow-up mammography. Fat necrosis, dystrophic calcifications, suture calcification features, breast edema, seroma and distorted breast are benign changes related to treatment. These findings may mimic or hide tumor recurrence making it difficult to diagnose recurrences or prevent inappropriate biopsies. Recurrent tumors in follow-up mammography show several typical findings such as increasing asymmetric density, enlarging mass, reappearance of breast edema, and micro-calcifications. The purpose of this pictorial review is to demonstrate and discuss mammographic findings of recurrent tumors and important post-treatment changes that may mimic benign or malignant lesions, also using breast ultrasound images or breast magnetic resonance images. Recognizing post-treatment changes may help radiologists to more effectively identify candidates for suspected local recurrences.
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Affiliation(s)
- Misugi Urano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Taeko Goto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Norio Shiraki
- Department of Radiology, Nagoya City West Medical Center
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Graduate School of Medical Sciences
| | | | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Tatsuya Toyama
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
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14
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Lewin AA, Moy L, Baron P, Didwania AD, diFlorio-Alexander RM, Hayward JH, Le-Petross HT, Newell MS, Rewari A, Scheel JR, Stuckey AR, Suh WW, Ulaner GA, Vincoff NS, Weinstein SP, Slanetz PJ. ACR Appropriateness Criteria® Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women. J Am Coll Radiol 2019; 16:S428-S439. [DOI: 10.1016/j.jacr.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/21/2022]
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15
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Wernli KJ, Ichikawa L, Kerlikowske K, Buist DSM, Brandzel SD, Bush M, Johnson D, Henderson LM, Nekhlyudov L, Onega T, Sprague BL, Lee JM, Lehman CD, Miglioretti DL. Surveillance Breast MRI and Mammography: Comparison in Women with a Personal History of Breast Cancer. Radiology 2019; 292:311-318. [PMID: 31161975 PMCID: PMC6694722 DOI: 10.1148/radiol.2019182475] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/05/2019] [Accepted: 04/12/2019] [Indexed: 01/24/2023]
Abstract
Background There is lack of consensus regarding the use of breast MRI for routine surveillance for second breast cancer events in women with a personal history of breast cancer. Purpose To compare performance of surveillance mammography with breast MRI. Materials and Methods This observational cohort study used prospectively collected data and included 13 266 women age 18 years and older (mean age, 60 years ± 13) with stage 0-III breast cancer who underwent 33 938 mammographic examinations and 2506 breast MRI examinations from 2005 to 2012 in the Breast Cancer Surveillance Consortium. Women were categorized into two groups: mammography alone (n = 11 745) or breast MRI (n = 1521). Performance measures were calculated by using end-of-day assessment and occurrence of second breast cancer events within 1 year of imaging. Logistic regression was used to compare performance for breast MRI versus mammography alone, adjusting for women, examination, and primary breast cancer characteristics. Analysis was conducted on a per-examination basis. Results Breast MRI was associated with younger age at diagnosis, chemotherapy, and higher education and income. Raw performance measures for breast MRI versus mammography were as follows, respectively: cancer detection rates, 10.8 (95% confidence interval [CI]: 6.7, 14.8) versus 8.2 (95% CI: 7.3, 9.2) per 1000 examinations; sensitivity, 61.4% (27 of 44; 95% CI: 46.5%, 76.2%) versus 70.3% (279 of 397; 95% CI: 65.8%, 74.8%); and biopsy rate, 10.1% (253 of 2506; 95% CI: 8.9%, 11.3%) versus 4.0% (1343 of 33 938; 95% CI: 3.7%, 4.2%). In multivariable models, breast MRI was associated with higher biopsy rate (odds ratio [OR], 2.2; 95% CI: 1.9, 2.7; P < .001) and cancer detection rate (OR, 1.7; 95% CI: 1.1, 2.7; P = .03) than mammography alone. However, there were no differences in sensitivity (OR, 1.1; 95% CI: 0.4, 2.9; P = .84) or interval cancer rate (OR, 1.1; 95% CI: 0.6, 2.2; P = .70). Conclusion Comparison of the performance of surveillance breast MRI with mammography must account for patient characteristics. Whereas breast MRI leads to higher biopsy and cancer detection rates, there were no significant differences in sensitivity or interval cancers compared with mammography. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Newell in this issue.
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Affiliation(s)
- Karen J. Wernli
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Laura Ichikawa
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Karla Kerlikowske
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Diana S. M. Buist
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Susan D. Brandzel
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Mary Bush
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Dianne Johnson
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Louise M. Henderson
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Larissa Nekhlyudov
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Tracy Onega
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Brian L. Sprague
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Janie M. Lee
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Constance D. Lehman
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
| | - Diana L. Miglioretti
- From the Kaiser Permanente Washington Health Research Institute, 1730
Minor Ave, Suite 1600, Seattle, WA 98101 (K.J.W., L.I., D.S.M.B., S.D.B., M.B.,
D.J., D.L.M.); Departments of Medicine and Epidemiology and Biostatistics,
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Radiology,
University of North Carolina, Chapel Hill, NC (L.M.H.); Department of Medicine,
Brigham and Women’s Hospital, Boston, Mass (L.N.); Department of
Biomedical Data Science, Norris Cotton Cancer Center, Dartmouth Medical School,
Hanover, NH (T.O.); Departments of Surgery and Radiology, University of Vermont,
Burlington, Vt (B.L.S.); Department of Radiology, University of Washington,
Seattle Cancer Care Alliance Seattle, Wash (J.M.L.); Department of Radiology,
Massachusetts General Hospital, Boston, Mass (C.D.L.); Department of Public
Health Sciences, University of California, Davis, Davis, Calif (D.L.M.)
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16
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McBride ML, Groome PA, Decker K, Kendell C, Jiang L, Whitehead M, Li D, Grunfeld E. Adherence to quality breast cancer survivorship care in four Canadian provinces: a CanIMPACT retrospective cohort study. BMC Cancer 2019; 19:659. [PMID: 31272420 PMCID: PMC6610964 DOI: 10.1186/s12885-019-5882-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In order to maximize later health, there are established components and guidelines for quality follow-up care of breast cancer survivors. However, adherence to quality follow-up in Canada may not be optimal, and may vary by province. We determined and compared the proportion of patients in each province who received adherent and non-adherent surveillance for recurrence, new cancers and late effects, recommended preventive care, and recommended physician visits for comorbidities. METHODS Cohorts consisted of all adult women diagnosed with incident invasive breast cancer between 2007 and 2010/2012 in four Canadian provinces (British Columbia (BC) N = 9338; Manitoba N = 2688; Ontario N = 23,700; Nova Scotia (NS) N = 2735), identified from provincial cancer registries, alive and cancer-free at 30 months post-diagnosis. Their healthcare utilization was determined from one to 5 years post-treatment, using linked administrative databases. Adherence, underuse, and overuse of recommended services were evaluated yearly and compared using descriptive statistics. RESULTS In all provinces and follow-up years, the majority of survivors had more than the recommended number of visits to either an oncologist or primary care physician (range 53.8% NS Year 3; 85.8% Ontario Year 4). The proportion of patients with the guideline-recommended number of oncologist visits varied by province (range 29.8% BC Year 5; 74.8% Ontario Year 5), and the proportion of patients with less than the recommended number of specified breast cancer-related visits with either an oncologist or primary care physician ranged from 32.6% (Ontario Year 2) to 84.4% (NS Year 3). Underuse of surveillance breast imaging was identified in NS and BC. The proportion of patients receiving imaging for metastatic disease (not recommended in the guidelines) in BC, Manitoba, and Ontario (not reported in NS) ranged from 20.3% (BC Year 5) to 53.3% (Ontario Year 2). Compliance with recommended physician visits for patients with several chronic conditions was high in Ontario and NS. Preventive care was less than optimal in all provinces with available data. CONCLUSIONS Quality of breast cancer survivor follow-up care varies among provinces. Results point to exploration of factors affecting differences, province-specific opportunities for care improvement, and the value of administrative datasets for health system assessment.
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Affiliation(s)
- Mary L McBride
- Cancer Control Research, BC Cancer, 675 West 10th Avenue, Room 2.107, Vancouver, BC, V5Z 1L3, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, Canada
- Cancer Research Institute, Queen's University, Kingston, Canada
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Kathleen Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Cynthia Kendell
- Cancer Outcomes Research Program, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Li Jiang
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
- Critical Care Services Ontario, Toronto, Canada
| | - Marlo Whitehead
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Dongdong Li
- Cancer Control Research, BC Cancer, 675 West 10th Avenue, Room 2.107, Vancouver, BC, V5Z 1L3, Canada
| | - Eva Grunfeld
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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17
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Teysir J, Gegechkori N, Wisnivesky JP, Lin JJ. Racial disparities in surveillance mammography among older breast cancer survivors. Breast Cancer Res Treat 2019; 176:461-467. [DOI: 10.1007/s10549-019-05250-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/20/2019] [Indexed: 12/16/2022]
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18
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Doria-Rose VP, Greenlee RT, Buist DSM, Miglioretti DL, Corley DA, Brown JS, Clancy HA, Tuzzio L, Moy LM, Hornbrook MC, Brown ML, Ritzwoller DP, Kushi LH, Greene SM. Collaborating on Data, Science, and Infrastructure: The 20-Year Journey of the Cancer Research Network. EGEMS (WASHINGTON, DC) 2019; 7:7. [PMID: 30972356 PMCID: PMC6450242 DOI: 10.5334/egems.273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/16/2018] [Indexed: 12/13/2022]
Abstract
The Cancer Research Network (CRN) is a consortium of 12 research groups, each affiliated with a nonprofit integrated health care delivery system, that was first funded in 1998. The overall goal of the CRN is to support and facilitate collaborative cancer research within its component delivery systems. This paper describes the CRN's 20-year experience and evolution. The network combined its members' scientific capabilities and data resources to create an infrastructure that has ultimately supported over 275 projects. Insights about the strengths and limitations of electronic health data for research, approaches to optimizing multidisciplinary collaboration, and the role of a health services research infrastructure to complement traditional clinical trials and large observational datasets are described, along with recommendations for other research consortia.
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Affiliation(s)
- V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
| | | | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
- University of California Davis School of Medicine, Davis, CA, US
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Jeffrey S. Brown
- Department of Population Medicine, Harvard Medical School, Boston, MA, US
- Harvard Pilgrim Health Care Institute, Boston, MA, US
| | - Heather A. Clancy
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Lisa M. Moy
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Mark C. Hornbrook
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, US
- Retired
| | - Martin L. Brown
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, US
- Retired
| | | | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
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Survivorship issues in older breast cancer survivors. Breast Cancer Res Treat 2018; 174:47-53. [PMID: 30506112 DOI: 10.1007/s10549-018-05078-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE Almost half of breast cancer survivors are aged ≥ 65 years and the proportion is likely to increase due to the aging of the population. The objectives of this article were to review studies of health outcomes among older breast cancer survivors ≥ 65 years to identify gaps in the published literature and offer suggestions for future research. METHODS The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from January 1, 1970 through October 1, 2018 were identified using the following MeSH search terms and Boolean algebra commands. RESULTS This review has revealed that older breast cancer survivors cope with health issues related to cancer treatment and the aging process, including comorbidities, osteoporosis, symptoms, physical functioning, cognitive functioning, nutrition, and physical activity. CONCLUSIONS Additional research is needed to examine therapeutic interventions to address the health conditions older breast cancer survivors are coping with. Particular focus of further research should be on the nutritional status and physical activity levels of older breast cancer survivors. Individualized nutrition plans and tailored physical activity programs for older survivors are needed that meet people where they are and that form habits.
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Houssami N, Cho N. Screening women with a personal history of breast cancer: overview of the evidence on breast imaging surveillance. Ultrasonography 2018; 37:277-287. [PMID: 30056638 PMCID: PMC6177686 DOI: 10.14366/usg.18017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/07/2018] [Indexed: 12/25/2022] Open
Abstract
This work reviews the evidence on breast imaging for screening (surveillance) in women with a history of breast cancer (BC). Early detection of second BCs in these women improves their prognosis based on studies using mammography (usually with clinical examinations) for surveillance. Cohort studies have estimated that mammography surveillance has moderate sensitivity (65.4%) and good specificity (98.3%), and have shown that these women are at a higher risk of interval BC than age- and breast density-matched women without a history of BC. Studies of adjunct imaging (ultrasound, magnetic resonance imaging) for surveillance that have reported detection and accuracy measures have generally shown that adjunct imaging detected more second BCs than mammography and added substantially to the amount of false-positive results; however, little evidence exists regarding screening efficacy of adjunct imaging as part of routine surveillance.
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Affiliation(s)
- Nehmat Houssami
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Elimova E, Wang X, Qiao W, Sudo K, Wadhwa R, Shiozaki H, Shimodaira Y, Planjery V, Charalampakis N, Lee JH, Weston BR, Bhutani MS, Komaki R, Rice DC, Swisher SG, Blum MA, Rogers JE, Skinner HD, Maru DM, Hofstetter WL, Ajani JA. Actionable Locoregional Relapses after Therapy of Localized Esophageal Cancer: Insights from a Large Cohort. Oncology 2018; 94:345-353. [PMID: 29705797 DOI: 10.1159/000486720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The goal of surveillance after therapy of localized esophageal cancer (LEC) is to identify actionable relapses amenable to salvage; however, the current surveillance algorithms are not optimized. We report on a large cohort of LEC patients with actionable locoregional relapses (LRRs). METHODS Between 2000 and 2013, 127 (denominator = 752) patients with actionable LRR were identified. Histologic/cytologic confirmation was the gold standard. All surveillance tools (imaging, endoscopy, fine needle aspiration) were assessed. RESULTS Most patients were men (89%), had adenocarcinoma (79%), and had no new symptoms (72%) when diagnosed with LRR. In trimodality patients, endoscopic confirmation of positron emission tomography-computed tomography-suspected LRR occurred in only 44%, and 56% required additional tools (e.g., fine needle aspiration). Alternatively, in bimodality patients, endoscopy confirmed LRRs in 81%. Trimodality patients had a higher risk of subsequent LRR/distant metastases after the first LRR than the bimodality patients (p = 0.03). In all patients, 78% of the subsequent relapses were distant. For patients who were salvaged, survival was significantly prolonged (50.6 vs. 25.1 months, p < 0.01). CONCLUSIONS Patients live longer after successful salvage of the LRR than if salvage is not possible. After LRR, patients have a high risk of subsequent distant metastasis and whether the second relapse is local or distant, survival is uniformly poor.
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Affiliation(s)
- Elena Elimova
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.,Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Xuemei Wang
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Wei Qiao
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Kazuki Sudo
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Roopma Wadhwa
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Hironori Shiozaki
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Yusuke Shimodaira
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Venkatram Planjery
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Nikolaos Charalampakis
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Brian R Weston
- Department of Gastroenterology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ritsuko Komaki
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - David C Rice
- Department of Thoracic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Stephen G Swisher
- Department of Thoracic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Mariela A Blum
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jane E Rogers
- Department of Clinical Pharmacy, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Heath D Skinner
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Dipen M Maru
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Wayne L Hofstetter
- Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Adesoye T, Schumacher JR, Neuman HB, Edge S, McKellar D, Winchester DP, Francescatti AB, Greenberg CC. Use of Breast Imaging After Treatment for Locoregional Breast Cancer (AFT-01). Ann Surg Oncol 2018; 25:1502-1511. [PMID: 29450753 DOI: 10.1245/s10434-018-6359-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Annual mammography is recommended after breast cancer treatment. However, studies suggest its under-utilization for Medicare patients. Utilization in the broader population is unknown, as is the role of breast magnetic resonance imaging (MRI). Understanding factors associated with imaging use is critical to improvement of adherence to recommendations. METHODS A random sample of 9835 eligible patients receiving surgery for stages 2 and 3 breast cancer from 2006 to 2007 was selected from the National Cancer Database for primary data collection. Imaging and recurrence data were abstracted from patients 90 days after surgery to 5 years after diagnosis. Factors associated with lack of imaging were assessed using multivariable repeated measures logistic regression with generalized estimating equations. Patients were censored for death, bilateral mastectomy, new cancer, and recurrence. RESULTS Of 9835 patients, 9622, 8702, 8021, and 7457 patients were eligible for imaging at surveillance years 1 through 4 respectively. Annual receipt of breast imaging declined from year 1 (69.5%) to year 4 (61.0%), and breast MRI rates decreased from 12.5 to 5.8%. Lack of imaging was associated with age 80 years or older and age younger than 50 years, black race, public or no insurance versus private insurance, greater comorbidity, larger node-positive hormone receptor-negative tumor, excision alone or mastectomy, and no chemotherapy (p < 0.005). Receipt of breast MRI was associated with age younger than 50 years, white race, higher education, private insurance, mastectomy, chemotherapy, care at a teaching/research facility, and MRI 12 months before diagnosis (p < 0.05). CONCLUSION Under-utilization of mammography after breast cancer treatment is associated with sociodemographic and clinical factors, not institutional characteristics. Effective interventions are needed to increase surveillance mammography for at-risk populations. ClinicalTrials.gov Identifier: NCT02171078.
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Affiliation(s)
- Taiwo Adesoye
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jessica R Schumacher
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Heather B Neuman
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Daniel McKellar
- American College of Surgeons, Commission On Cancer, Chicago, IL, USA
| | | | | | - Caprice C Greenberg
- Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Hwong AR, Mangurian C. Improving Breast Cancer Screening and Care for Women With Severe Mental Illness. J Clin Oncol 2017; 35:3996-3998. [PMID: 29095679 DOI: 10.1200/jco.2017.76.0462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alison R Hwong
- Alison R. Hwong and Christina Mangurian, University of California, San Francisco, San Francisco, CA
| | - Christina Mangurian
- Alison R. Hwong and Christina Mangurian, University of California, San Francisco, San Francisco, CA
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Variability of Postsurgical Imaging Surveillance of Breast Cancer Patients: A Nationwide Survey Study. AJR Am J Roentgenol 2017; 210:222-227. [PMID: 29064749 DOI: 10.2214/ajr.17.17923] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Because of observed clinical variance and the discretion of referring physicians and radiologists in patient follow-up, the purpose of this study was to conduct a survey to explore whether broad discrepancy exists in imaging protocols used for postsurgical surveillance. SUBJECTS AND METHODS An online survey was created to assess radiologists' use of diagnostic versus screening mammography for women with a personal history of breast cancer and determine whether the choice of protocol was associated with practice characteristics (setting, region, and reader type). RESULTS Of 8170 surveys sent, 849 (10%) completed responses were returned. Seventy-nine percent of respondents recommended initial diagnostic mammography after lumpectomy (65% at 6 months, 14% at 12 months); 49% recommended diagnostic surveillance for up to 2 years before a return to screening mammography; and 33% continued diagnostic surveillance for 2-5 years before returning to screening. For imaging after mastectomy, 57% of respondents recommended diagnostic mammography of the unaffected breast. Among the 57%, however, 37% recommended diagnostic screening for only the first postmastectomy follow-up evaluation, and the other 20% permanently designated patients for diagnostic mammography after mastectomy. CONCLUSION The optimal surveillance mammography regimen must be better defined. This preliminary study showed variability in diagnostic versus screening surveillance mammography for women with a history of breast cancer. Future studies should evaluate why these variations occur and how to standardize recommendations to tailor personalized imaging.
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Kim HS, Kang SH. Utility of Regular Radiological Follow-up on Early Detection of Contralateral Malignancy and Long-term Outcomes in Metachronous Bilateral Breast Cancer Patients. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives We investigated the utility of regular radiological follow-up on the early detection of contralateral breast cancer(CBC) and prognosis in patients with metachronous bilateral breast cancer. Methods Between 1983 and 2010, 49(2.1%) metachronous bilateral breast cancer patients were identified among a total of 2,343 cases of invasive or in situ breast carcinomas. We reviewed the patients' medical records including age, stage, duration between the first and second breast cancer diagnosis, operation method, recurrence, and breast cancer-specific survival. Results The mean ages at the first and second breast cancer diagnosis were 43.8 and 49.2 years, respectively. The mean duration between the first and second breast cancer diagnosis was 68.9 months (range, 7–266 months). Regular radiological follow-up with annual mammography(MMG) with or without ultrasonography was conducted in 28 patients (63.6%, Group 1), and no regular follow-up was performed in 12 patients (27.3%, Group 2). The median follow-up duration was 150 months. In a comparative analysis, Group 1 patients exhibited more stage 0 and stage 1 malignancies (82.1% vs. 25%, P =0.006) as second cancer and the same or an improved stage (71.4% vs. 33.3%, P =0.042) of second cancer compared to Group 2 patients. Breast cancer-specific survival rates between the two groups after the first cancer occurrence were higher in Group 1 patients compared to Group 2 patients, although this did not reach statistical significance. Conclusion Screening for CBC with regular radiological follow-up could result in early detection of CBC, less invasive surgical procedures, and enhanced breast cancer-specific survival outcomes.
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Agopian A, Dubot C, Houzard S, Savignoni A, Fridmann S, Odier A, Fourquet A, Fourchotte V, Dehghani C, Nos C, Delaloge S, Zongo N, Cottu P. Pattern of relapse in low-risk breast cancer patients followed within a community care network. Breast J 2017; 23:687-693. [PMID: 28556478 DOI: 10.1111/tbj.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 01/04/2023]
Abstract
International guidelines have set the frame and methods of patients' surveillance after early breast cancer (BC) treatment. Since 1998, delegation of low-risk BC patients follow-up to nonhospital practitioners has been developed within a care network in the Paris region. We used the Gynecomed care network digital database to describe the characteristics of oncological events which occurred in the cohort, and to assess the quality of BC follow-up in relapsing patients. Events were defined as any local, contralateral, or metastatic recurrence, as well as second cancer or death due to any cause. We developed a ranked evaluation method of our surveillance program. Among the 3019 patients followed in the network, 116 (4.3%) patients had 116 events. Median follow-up was 7.1 years (0-51). First events were local-regional relapses, contralateral BCs, metastatic events, second primaries in respectively 52, 26, 14, 24 cases. During the first 5 years, 68.4% of surveillance visits were performed on time, 13.5% were behind schedule and 18.1% were not performed, while 79.1% of mammographies were performed on time, 7.7% behind schedule, and 13.2% were not performed. On schedule examinations allowed diagnosis of 77% of the local-regional, ipsilateral relapses or contralateral BCs, including 38 (69%) discovered by mammographies and 17 (31%) by clinical examination. A nonhospital practitioner care network is able to comply with good surveillance practices and deliver high quality surveillance, in accordance with international guidelines. Delegation of low-risk BC surveillance to nonhospital practitioners is reliable.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Claude Nos
- Hôpital Européen Georges Pompidou, Paris Cedex, France
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Moy L, Bailey L, D'Orsi C, Green ED, Holbrook AI, Lee SJ, Lourenco AP, Mainiero MB, Sepulveda KA, Slanetz PJ, Trikha S, Yepes MM, Newell MS. ACR Appropriateness Criteria ® Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women. J Am Coll Radiol 2017; 14:S282-S292. [PMID: 28473085 DOI: 10.1016/j.jacr.2017.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/17/2022]
Abstract
Women and health care professionals generally prefer intensive follow-up after a diagnosis of breast cancer. However, there are no survival differences between women who obtain intensive surveillance with imaging and laboratory studies compared with women who only undergo testing because of the development of symptoms or findings on clinical examinations. American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines state that annual mammography is the only imaging examination that should be performed to detect a localized breast recurrence in asymptomatic patients; more imaging may be needed if the patient has locoregional symptoms (eg, palpable abnormality). Women with other risk factors that increase their lifetime risk for breast cancer may warrant evaluation with breast MRI. Furthermore, the quality of life is similar for women who undergo intensive surveillance compared with those who do not. There is little justification for imaging to detect or rule out metastasis in asymptomatic women with newly diagnosed stage I breast cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Linda Moy
- Principal Author, NYU Clinical Cancer Center, New York, New York.
| | - Lisa Bailey
- Bay Area Breast Surgeons, Emeryville, California; American College of Surgeons
| | | | - Edward D Green
- The University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Su-Ju Lee
- University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Sunita Trikha
- North Shore University Hospital, Manhasset, New York
| | | | - Mary S Newell
- Panel Chair, Emory University Hospital, Atlanta, Georgia
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Wirtz HS, Calip GS, Buist DSM, Gralow JR, Barlow WE, Gray S, Boudreau DM. Evidence for Detection Bias by Medication Use in a Cohort Study of Breast Cancer Survivors. Am J Epidemiol 2017; 185:661-672. [PMID: 28338879 DOI: 10.1093/aje/kww242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 05/06/2016] [Indexed: 12/23/2022] Open
Abstract
In previous studies, we found modestly decreased and increased risks of second breast cancer events with the use of statins and antibiotics, respectively, after adjustment for surveillance mammography. We evaluated detection bias by comparing receipt of surveillance mammography among users of these 2 disparate classes of medication. Adult women diagnosed with early-stage breast cancer during 1990-2008 (n = 3,965) while enrolled in an integrated health-care plan (Group Health Cooperative; Washington State) were followed for up to 10 years in the Commonly Used Medications and Breast Cancer Outcomes (COMBO) Study. Categories of antibiotic use included infrequent (1-3 dispensings/12 months) and frequent (≥4 dispensings/12 months) use, and categories of statin use included less adherent (1 dispensing/6 months) and adherent (≥2 dispensings/6 months). We examined associations between medication use and surveillance mammography using multivariable generalized estimating equations and evaluated the impact of adjusting for surveillance within Cox proportional hazard models. Frequent antibiotic users were less likely to receive surveillance mammography (odds ratio (OR) = 0.90, 95% confidence interval (CI): 0.82, 0.99) than were nonusers; no association was found among infrequent users (OR = 0.96, 95% CI: 0.90, 1.03). Adherent statin use was associated with more surveillance compared with nonuse (OR = 1.11, 95% CI: 1.01, 1.25), but less adherent statin use was not (OR = 1.03, 95% CI: 0.81, 1.31). No difference in associations between medications of interest and second breast cancer events was observed when surveillance was removed from otherwise adjusted models. The influence of detection bias by medication use warrants further exploration.
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Freedman RA, Keating NL, Partridge AH, Muss HB, Hurria A, Winer EP. Surveillance Mammography in Older Patients With Breast Cancer-Can We Ever Stop?: A Review. JAMA Oncol 2017; 3:402-409. [PMID: 27892991 PMCID: PMC5540165 DOI: 10.1001/jamaoncol.2016.3931] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Approximately 4% to 5% of breast cancer survivors will develop a new ipsilateral or contralateral cancer (in-breast event) over the 5 years following diagnosis, and annual surveillance mammography is recommended for those with residual breast tissue. The risk for such in-breast events persists over time, though increasing age at cancer diagnosis and treatment with hormonal therapy are associated with lower risk, and most older survivors of breast cancer will ultimately die from nonbreast cancer-related causes. Specific guidelines for surveillance strategies in older patients are limited. Prospective data on the benefits and harms of surveillance mammography in this population are lacking, and most of the evidence is derived from observational, retrospective data, often in the general population. OBSERVATIONS We review the current recommendations for breast cancer screening and surveillance for older patients, the current evidence for ipsilateral and contralateral breast cancer risks in older survivors of breast cancer, and suggested approaches for discussions about surveillance mammography with older patients. We recommend individualized decision making for surveillance breast imaging in older survivors of breast cancer, with consideration of the following strategy for women 70 years or older: 1-time imaging 6 to 12 months after completion of local therapy followed by annual or biennial surveillance mammography for healthy women and cessation of mammography in patients whose life expectancy is less than 5 years to 10 years, regardless of age. Decisions on mammographic surveillance should also incorporate whether hormonal therapy is being administered, whether a patient's anticipated life expectancy is extraordinary, and whether a patient's individual risk for in-breast events is higher (or lower) than average risk for breast cancer survivors. CONCLUSIONS AND RELEVANCE We propose reframing discussions around surveillance mammography in older breast cancer survivors and to consider cessation while taking into account life expectancy, the estimated risk for subsequent in-breast events, and patient preferences.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts3Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hyman B Muss
- Department of Medicine, University of North Carolina, Chapel Hill
| | - Arti Hurria
- Department of Medical Oncology, City of Hope, Duarte, California
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Follow-Up of Patients with Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paszat LF, Sutradhar R, Gu S, Rakovitch E. Annual surveillance mammography after early-stage breast cancer and breast cancer mortality. ACTA ACUST UNITED AC 2016; 23:e538-e545. [PMID: 28050142 DOI: 10.3747/co.23.3399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND After treatment for early-stage breast cancer (bca), annual surveillance mammography (asm) is recommended based on the assumption that early detection of an invasive ipsilateral breast tumour recurrence or subsequent invasive contralateral primary bca reduces bca mortality. METHODS We studied women with unilateral early-stage bca treated by breast-conserving surgery from 1994 to 1997 who subsequently developed an ipsilateral recurrence or contralateral primary more than 24 months after initial diagnosis, without prior regional or distant metastases. Annual surveillance mammography was defined as 2 episodes of bilateral mammography 11-18 months apart during the 2 years preceding the ipsilateral recurrence or contralateral primary. The association between asm and bca death was evaluated using a Cox proportional hazards model. RESULTS We identified 669 women who experienced invasive ipsilateral recurrence (n = 455) or a contralateral primary (n = 214) at a median interval of 53 months [interquartile range (iqr): 37-72 months] after initial diagnosis, 64.7% of whom had received asm during the preceding 2 years. The median interval between the 2 bilateral mammograms was 12.3 months (iqr: 11.9-13.0 months), and the median interval between the 2nd mammogram and histopathologic confirmation of ipsilateral recurrence or contralateral primary was 1.5 months (iqr: 0.8-3.9 months). Median followup after ipsilateral recurrence or contralateral primary was 7.76 years (iqr: 3.68-9.81 years). The adjusted hazard ratio for bca death associated with asm was 0.86 (95% confidence limits: 0.63, 1.16). CONCLUSIONS Annual surveillance mammography was associated with a modestly lowered hazard ratio for bca death.
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Affiliation(s)
- L F Paszat
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - R Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - S Gu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - E Rakovitch
- Institute for Clinical Evaluative Sciences, Toronto, ON
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Bucchi L, Belli P, Benelli E, Bernardi D, Brancato B, Calabrese M, Carbonaro LA, Caumo F, Cavallo-Marincola B, Clauser P, Fedato C, Frigerio A, Galli V, Giordano L, Golinelli P, Mariscotti G, Martincich L, Montemezzi S, Morrone D, Naldoni C, Paduos A, Panizza P, Pediconi F, Querci F, Rizzo A, Saguatti G, Tagliafico A, Trimboli RM, Zuiani C, Sardanelli F. Recommendations for breast imaging follow-up of women with a previous history of breast cancer: position paper from the Italian Group for Mammography Screening (GISMa) and the Italian College of Breast Radiologists (ICBR) by SIRM. LA RADIOLOGIA MEDICA 2016; 121:891-896. [PMID: 27601142 PMCID: PMC5102938 DOI: 10.1007/s11547-016-0676-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/16/2016] [Indexed: 10/25/2022]
Abstract
Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0-1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15-20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient's age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, via Piero Maroncelli, 40, 47014, Meldola, Forlì, Italy
| | - Paolo Belli
- Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 0168, Rome, Italy
| | - Eva Benelli
- Zadig Scientific Communication Agency, via Arezzo 21, 00161, Rome, Italy
| | - Daniela Bernardi
- Dipartimento di Radiologia, U.O. Senologia Clinica e Screening Mammografico, APSS, Centro per i Servizi Sanitari, Pal. C, viale Verona, 38123, Trento, Italy
| | - Beniamino Brancato
- Struttura Complessa di Senologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Massimo Calabrese
- UOC Senologia Diagnostica, IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Luca A Carbonaro
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Francesca Caumo
- UOSD Breast Unit ULSS20, Piazza Lambranzi 1, 37142, Verona, Italy
| | - Beatrice Cavallo-Marincola
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, 1090, Verona, Austria
- Institute of Radiology, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy
| | - Chiara Fedato
- Regional Screening Coordinating Centre, Veneto Region, Venice, Italy
| | - Alfonso Frigerio
- Regional Reference Centre for Breast Cancer Screening, Turin, Italy
| | - Vania Galli
- Mammography Screening Centre, Local Health Authority, Modena, Italy
| | - Livia Giordano
- Epidemiology Unit, Centre for Cancer Prevention, Turin, Italy
| | - Paola Golinelli
- Medical Physics Service, Local Health Authority, Modena, Italy
| | - Giovanna Mariscotti
- Dipartimento di Diagnostica per Immagini, Radiologia 1U, Università di Torino, A. O. U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy
| | - Laura Martincich
- U.O. Radiodiagnostica, Candiolo Cancer Institute-FPO, IRCCS, Str. Prov. 142, km 3.95, I, 10060, Candiolo, Turin, Italy
| | - Stefania Montemezzi
- DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, P.le A. Stefani 1, 37126, Verona, Italy
| | - Doralba Morrone
- Struttura Complessa di Senologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Carlo Naldoni
- Department of Health, Emilia-Romagna Region, Bologna, Italy
| | - Adriana Paduos
- Epidemiology Unit, Centre for Cancer Prevention, Turin, Italy
| | - Pietro Panizza
- U.O. Radiologia Senologica, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Federica Pediconi
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fiammetta Querci
- Department of Prevention, Screening Centre, Local Health Authority, Sassari, Italy
| | - Antonio Rizzo
- Pathology Department, Local Health Authority, Asolo, Italy
| | | | - Alberto Tagliafico
- Department of Experimental Medicine, DIMES, Institute of Anatomy, University of Genova, Via de Toni 14, 16132, Genoa, Italy
| | - Rubina M Trimboli
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy
| | - Chiara Zuiani
- Institute of Radiology, University of Udine, P.le S. M. della Misericordia 15, 33100, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, Research Hospital (IRCCS) Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
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Moy L, Newell MS, Mahoney MC, Bailey L, Barke LD, Carkaci S, D’Orsi C, Goyal S, Haffty BG, Harvey JA, Hayes MK, Jokich PM, Lee SJ, Mainiero MB, Mankoff DA, Patel SB, Yepes MM. ACR Appropriateness Criteria Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women. J Am Coll Radiol 2016; 13:e43-e52. [DOI: 10.1016/j.jacr.2016.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Massimino KP, Jochelson MS, Burgan IE, Stempel M, Morrow M. How Beneficial is Follow-Up Mammography in Elderly Breast Cancer Survivors? Ann Surg Oncol 2016; 23:3518-3523. [PMID: 27306905 DOI: 10.1245/s10434-016-5301-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to determine the rate of non-palpable cancer detection and benign biopsy rates for follow-up mammograms in elderly breast cancer survivors. METHODS Women 80 years of age and older who underwent operation for ductal carcinoma in situ or invasive breast cancer from 2005 to 2010 and who had at least 6 months of follow-up were identified from a single-institution, prospectively maintained, Health Insurance Portability and Accountability Act (HIPAA)-compliant database. Patients with mammographic, other imaging, or palpable abnormalities were identified, and the results of their imaging studies and biopsies were reviewed. Number of locoregional recurrences, contralateral cancers, and benign biopsies were determined. Follow-up and survival data were recorded. RESULTS Overall, 429 women with a mean age of 83.4 years were included. Mean follow-up was 50.0 months (range 6-113). Patients had a median of four follow-up mammograms (range 0-11). The 1466 mammograms detected 17 biopsy-proven cancers and generated 18 benign biopsies. In the 305 women who had had breast-conserving surgery, 18 (5.9 %) experienced local recurrence, 9 detected by mammography alone (mean size 1.2 cm) and 9 palpable (mean size 2.0 cm). Contralateral cancer developed in 4 (0.9 %) of the 429 patients, all detected on screening mammogram alone. CONCLUSION Overall, 13 non-palpable breast cancers were detected in 1466 mammograms (0.9 %). While these results are acceptable for screening programs in healthy populations, further study of the need for routine follow-up imaging in the elderly, and the appropriate interval, is needed to maximize resource utilization.
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Affiliation(s)
- Kristen P Massimino
- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Maxine S Jochelson
- Breast Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Imelda E Burgan
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Barriers and facilitators to endocrine therapy adherence among underserved hormone-receptor-positive breast cancer survivors: a qualitative study. Support Care Cancer 2016; 24:4123-30. [PMID: 27146492 DOI: 10.1007/s00520-016-3229-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the barriers and facilitators to taking anti-hormonal medications among medically and historically underserved breast cancer survivors within the first 5 years post chemotherapy, radiation, and/or surgery. METHODS The current study was framed within the National Institutes of Health Centers for Population Health and Health Disparities Model (NIHCPHHD Model). Twenty-five historically or medically underserved breast cancer survivors participated in an in-depth interview, in either English or Spanish. Interviews were audio recorded and transcribed verbatim. Interview data were analyzed using content analysis. RESULTS Anti-hormonal medication adherence was facilitated in several ways, including establishing a routine of medication taking, leaving the medicine in a visible or easily accessible place, taking the medication with other medications, reducing the cost of medicine, using a pillbox, understanding the negative consequences of lack of adherence, and having positive interactions with physicians. Side effects were the most commonly mentioned barrier to medication adherence. CONCLUSIONS Similar to other research, this qualitative study of medically and historically underserved breast cancer survivors in the USA found that side effects are the most frequently endorsed barrier to anti-hormonal medication adherence. Conversely, there were a number of facilitators of correct and consistent anti-hormonal medication use. The management of side effects is critically important to increase adherence to anti-hormonal medications. Health care providers, support providers, and caregivers can encourage breast cancer survivors to better adhere to anti-hormonal medications using a number of approaches that have been successful for other women.
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Le point de vue de gynécologues impliquées dans le suivi après cancer du sein sur le PPAC. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Solanki PA, Ko NY, Qato DM, Calip GS. Risk of cancer-specific, cardiovascular, and all-cause mortality among Asian and Pacific Islander breast cancer survivors in the United States, 1991-2011. SPRINGERPLUS 2016; 5:82. [PMID: 26844029 PMCID: PMC4728166 DOI: 10.1186/s40064-016-1726-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 01/21/2023]
Abstract
Asian and Pacific Islander (API) women in the United States (U.S.) are a heterogeneous group reported to have better prognosis after breast cancer (BC) compared to their Non-Hispanic White (NHW) counterparts. Few studies have examined differences in BC survival between individual API ethnic groups. We conducted a retrospective cohort study of 462,005 NHW and 44,531 API women diagnosed with incident, stage I-III BC between 1991 and 2011 in the Surveillance, Epidemiology and End Results (SEER) 18 registries. SEER-reported API ethnicity was grouped as Chinese, Japanese, Filipino, Hawaiian, Korean, Vietnamese, Asian Indian and Pakistani, and Pacific Islander. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for risk of BC-specific, cardiovascular and all-cause mortality comparing API to NHW women. We also estimated mortality risk comparing U.S.-born to non-U.S.-born women. Compared to NHW women, API women overall had lower BC-specific, cardiovascular and all-cause mortality. BC-specific mortality risk was lowest among Japanese women (HR 0.69, 95 % CI 0.63-0.77). Other women had similar (Filipino, HR 0.93, 0.86-1.00; Hawaiian, HR 1.01, 0.89-1.17) or greater (Pacific Islander, HR 1.44, 1.17-1.78) risk of BC-specific death. Compared to non-U.S. born API women, findings were suggestive of increased cardiovascular (HR 1.12, 1.03-1.20) and all-cause mortality (HR 1.29, 1.08-1.54) among U.S.-born API women. Mortality risk varies greatly between BC survivors from different API backgrounds. Further research is warranted to understand these disparities in BC survivorship and the social and cultural factors that possibly contribute to greater mortality among later-generation API women born in the United States.
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Affiliation(s)
- Pooja A Solanki
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor St., Chicago, IL 60612 USA
| | - Naomi Y Ko
- Section of Hematology Oncology, Boston University, Boston Medical Center, 725 Albany St., Boston, MA 02118 USA
| | - Dima M Qato
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor St., Chicago, IL 60612 USA ; Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612 USA
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612 USA ; Population Health, Behavior and Outcomes Program, University of Illinois Cancer Center, 1801 W. Taylor St., Chicago, IL 60612 USA
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Dubot C, Donnadieu A, Houzard S, Fridmann S, Dehghani C, Dagousset I, Missey-Kolb H, Hassoun D. [Good reasons to develop the out-of-hospital follow-up after breast cancer]. J Gynecol Obstet Hum Reprod 2016; 45:98-99. [PMID: 26705607 DOI: 10.1016/j.jgyn.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Affiliation(s)
- C Dubot
- Service d'oncologie médicale, institut Curie/Site Paris, 5, rue Dailly, 92210 Saint-Cloud, France
| | - A Donnadieu
- Service de radiothérapie, institut Curie/Site Paris, 26, rue d'Ulm, 75005 Paris, France
| | - S Houzard
- Réseau Gynécomed IdF, 103, rue Legendre, 75017 Paris, France.
| | - S Fridmann
- Réseau Gynécomed IdF, 103, rue Legendre, 75017 Paris, France
| | - C Dehghani
- Service de chirurgie gynécologique, groupe hospitalier Diaconesses - Croix-Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
| | - I Dagousset
- Réseau Gynécomed IdF, 103, rue Legendre, 75017 Paris, France
| | - H Missey-Kolb
- Réseau Gynécomed IdF, 103, rue Legendre, 75017 Paris, France
| | - D Hassoun
- Réseau Gynécomed IdF, 103, rue Legendre, 75017 Paris, France
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Dawes AJ, Hemmelgarn M, Nguyen DK, Sacks GD, Clayton S, Cope J, Ganz PA, Maggard-Gibbons M. Are primary care providers prepared to care for survivors of breast cancer in the safety net? Cancer 2015; 121:1249-56. [PMID: 25536301 PMCID: PMC4393343 DOI: 10.1002/cncr.29201] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/10/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND With the growing number of survivors of breast cancer outpacing the capacity of oncology providers, there is pressure to transition patients back to primary care. Primary care providers (PCPs) working in safety-net settings may have less experience treating survivors, and little is known about their knowledge and views on survivorship care. The current study was performed to determine the knowledge, attitudes, and confidence of PCPs in the safety net at delivering care to survivors of breast cancer. METHODS A modified version of the National Cancer Institute's Survey of Physician Attitudes Regarding Care of Cancer Survivors was given to providers at 2 county hospitals and 5 associated clinics (59 providers). Focus groups were held to understand barriers to survivorship care. RESULTS Although the majority of providers believed PCPs have the skills necessary to provide cancer-related follow-up, the vast majority were not comfortable providing these services themselves. Providers were adherent to American Society of Clinical Oncology recommendations for mammography (98%) and physical examination (87%); less than one-third were guideline-concordant for laboratory testing and only 6 providers (10%) met all recommendations. PCPs universally requested additional training on clinical guidelines and the provision of written survivorship care plans before transfer. Concerns voiced in qualitative sessions included unfamiliarity with the management of endocrine therapy and confusion regarding who would be responsible for certain aspects of care. CONCLUSIONS Safety-net providers currently lack knowledge of and confidence in providing survivorship care to patients with breast cancer. Opportunities exist for additional training in evidence-based guidelines and improved coordination of care between PCPs and oncology specialists.
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Affiliation(s)
- Aaron J. Dawes
- Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
- RWJF Clinical Scholars Program, UCLA, Los Angeles, CA
| | | | - David K. Nguyen
- Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Greg D. Sacks
- Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA
- RWJF Clinical Scholars Program, UCLA, Los Angeles, CA
| | - Sheilah Clayton
- Martin Luther King, Jr./Charles R. Drew University Medical Center, Los Angeles, CA
| | | | - Patricia A. Ganz
- Department of Medicine, David Geffen School of Medicine UCLA, Los Angeles, CA
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Olive View/UCLA Medical Center, Sylmar, CA
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Kim KS, Kim Z, Shim EJ, Kim NH, Jung SY, Kim J, Sohn G, Lee JW, Cho J, Lee JE, Lee J, Youn HJ, Lee J, Lee MH. The reality in the follow-up of breast cancer survivors: survey of Korean Breast Cancer Society. Ann Surg Treat Res 2015; 88:133-9. [PMID: 25741492 PMCID: PMC4347047 DOI: 10.4174/astr.2015.88.3.133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose Follow-up after primary treatment for breast cancer is an important component of survivor care and various international guidelines exist for the surveillance. However, little is known about current actual practice patterns of physicians whether they adhere to or deviate from recommended guidelines. The aim of this study was to determine how physicians follow-up their patients after primary treatment for breast cancer in Korea. Methods A questionnaire survey with 34 questions in 4 categories was e-mailed to the members of Korean Breast Cancer Society from November to December 2013. Respondents were asked how they use follow-up modalities after primary treatment of breast cancer and we compared the survey results with present guidelines. Results Of the 129 respondents, 123 (95.3%) were breast surgeons. The most important consideration in follow-up was tumor stage. History taking, physical examinations, and mammography were conducted in similar frequency recommended by other guidelines while breast ultrasonography was performed more often. The advanced imaging studies such as CT, MRI, and bone scan, which had been recommended to be conducted only if necessary, were also examined more frequently. Regular screenings for secondary malignancy were performed in 38 respondents (29.5%). Five years later after primary treatment, almost the whole respondents (94.6%) themselves monitored their patients. Conclusion A majority of respondents have been performed more intensive follow-up modalities in comparison with present guidelines and less frequently screenings for secondary malignancy. For optimal follow-up of breast cancer survivors, tailored delivery system should be considered.
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Affiliation(s)
- Ku Sang Kim
- Department of Surgery, Breast-Thyroid Center, Ulsan City Hospital, Ulsan, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Eun-Jung Shim
- Department of Psychology, Pusan National University, Pusan, Korea
| | - Nam Hyoung Kim
- Department of Advertising and Branding, Kaywon University of Art and Design, Uiwang, Korea
| | - So-Youn Jung
- Breast Cancer Center, National Cancer Center, Goyang, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Guiyun Sohn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihyoung Cho
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Sookmyung Women's University, Seoul, Korea
| | - Juhyung Lee
- Department of Preventive Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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ACR Appropriateness Criteria Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women. J Am Coll Radiol 2014; 11:1160-8. [DOI: 10.1016/j.jacr.2014.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/26/2014] [Indexed: 11/22/2022]
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Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors. Breast Cancer Res Treat 2014; 143:541-50. [PMID: 24407530 DOI: 10.1007/s10549-013-2816-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/16/2013] [Indexed: 01/16/2023]
Abstract
Clinical practice guidelines recommend yearly surveillance mammography for breast cancer survivors, yet many women do not receive this service. The objective of this study was to evaluate factors related to long-term surveillance mammography adherence among breast cancer survivors. We conducted a retrospective cohort study among women ≥ 18 years, diagnosed with incident stage I or II breast cancer between 1990 and 2008. We used medical record and administrative health plan data to ascertain covariates and receipt of surveillance mammography for up to 10 years after completing breast cancer treatment. Surveillance included post-diagnosis screening exams among asymptomatic women. We used multivariable repeated measures generalized estimating equation regression models to estimate odds ratios and robust 95 % confidence intervals to examine factors related to the annual receipt of surveillance mammography. The analysis included 3,965 women followed for a median of six surveillance years; 79 % received surveillance mammograms in year 1 but decreased to 63 % in year 10. In multivariable analyses, women, who were < 40 years or 80+ years of age (compared to 50-59 years), current smokers, had greater comorbidity, were diagnosed more recently, had stage II cancer, or were treated with mastectomy or breast conserving surgery without radiation, were less likely than other women to receive surveillance mammography. Women with outpatient visits during the year to primary care providers, oncologists, or both were more likely to undergo surveillance. In this large cohort study of women diagnosed with early-stage invasive breast cancer, we found that important subgroups of women are at high risk for non-adherence to surveillance recommendations, even among younger breast cancer survivors. Efforts should be undertaken to actively engage breast cancer survivors in managing long-term surveillance care.
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Abstract
BACKGROUND Most data regarding medical care for cancer patients in the United States comes from Surveillance, Epidemiology and End Results-linked Medicare analyses of individuals aged 65 years or older and typically excludes Medicare Advantage enrollees. OBJECTIVES To assess the accuracy of chemotherapy and hormone therapy treatment data available through the Cancer Research Network's Virtual Data Warehouse (VDW). RESEARCH DESIGN Retrospective, longitudinal cohort study. Medical record-abstracted, tumor registry-indicated treatments (gold standard) were compared with VDW-indicated treatments derived from health maintenance organization pharmacy, electronic medical record, and claim-based data systems. SUBJECTS Enrollees aged 18 years and older diagnosed with incident breast, colorectal, lung, or prostate cancer from 2000 through 2007. MEASURES Sensitivity, specificity, and positive predictive value were computed at 6 and 12 months after cancer diagnosis. RESULTS Approximately 45% of all cancer cases (total N=23,800) were aged 64 years or younger. Overall chemotherapy sensitivity/specificities across the 3 health plans for incident breast, colorectal, lung, and prostate cancer cases were 95%/90%, 95%/93%, 93%/93%, and 85%/77%, respectively. With the exception of prostate cancer cases, overall positive predictive value ranged from 86% to 89%. Small variations in chemotherapy data accuracy existed due to cancer site and data source, whereas greater variation existed in hormone therapy capture across sites. CONCLUSIONS Strong concordance exists between gold standard tumor registry measures of chemotherapy receipt and Cancer Research Network VDW data. Health maintenance organization VDW data can be used for a variety of studies addressing patterns of cancer care and comparative effectiveness research that previously could only be conducted among elderly Surveillance, Epidemiology and End Results-Medicare populations.
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Smith-Gagen J, Carrillo JE, Ang A, Pérez-Stable EJ. Practices that reduce the Latina survival disparity after breast cancer. J Womens Health (Larchmt) 2013; 22:938-46. [PMID: 24106867 PMCID: PMC3820127 DOI: 10.1089/jwh.2012.4235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Latina breast cancer patients are 20 percent more likely to die within 5 years after diagnosis compared with white women, even though they have a lower incidence of breast cancer, lower general mortality rates, and some better health behaviors. Existing data only examine disparities in the utilization of breast cancer care; this research expands the study question to which utilization factors drive the shorter survival in Latina women compared with white women. METHODS This longitudinal linked Surveillance Epidemiology and End Results (SEER)-Medicare cohort study examined early stage breast cancer patients diagnosed between 1992 and 2000 and followed for 5-11 years after diagnosis (N=44,999). Modifiable utilization factors included consistent visits to primary care providers and to specialists after diagnosis, consistent post-diagnosis mammograms, and receipt of initial care consistent with current standards of care. RESULTS Of the four utilization factors potentially driving this disparity, a lack of consistent post-diagnosis mammograms was the strongest driver of the Latina breast cancer survival disparity. Consistent mammograms attenuated the hazard of death from 23% [hazard ratio, HR, (95% confidence interval, 95%CI)=1.23 (1.1,1.4)] to a nonsignificant 12% [HR (95%CI)=1.12 (0.7,1.3)] and reduced the excess hazard of death in Latina women by 55%. Effect modification identified that visits to primary care providers have a greater protective impact on the survival of Latina compared to white women [HR (95%CI)=0.9 (0.9,0.9)]. CONCLUSIONS We provide evidence that undetected new or recurrent breast cancers due to less consistent post-diagnosis mammograms contribute substantially to the long-observed Latina survival disadvantage. Interventions involving primary care providers may be especially beneficial to this population.
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Affiliation(s)
- Julie Smith-Gagen
- 1 School of Community Health Sciences, University of Nevada , Reno, Nevada
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Parmar AD, Sheffield KM, Vargas GM, Han Y, Chao C, Riall TS. Quality of post-treatment surveillance of early stage breast cancer in Texas. Surgery 2013; 154:214-25. [PMID: 23889950 DOI: 10.1016/j.surg.2013.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Only annual mammography and physical examination are recommended for the post-treatment surveillance of early stage breast cancer. METHODS We used Texas Cancer Registry-Medicare linked data (2001-2007) to identify physician visits and use of mammography, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) CT in patients ≥ 66 years old with ductal carcinoma in situ and stage I-III ductal carcinoma who underwent curative-intent operations. We also evaluated the trends in use of recommended and nonrecommended tests. RESULTS We identified 8,598 patients with resected ductal carcinoma in situ (37.3%) or invasive ductal cancer (62.7%). Breast-conserving therapy was performed in 59%. Only 55% saw a physician twice a year for 2 years and underwent annual mammography for 2 consecutive years in the surveillance period. Mammography use decreased from 81% in 2001 to 75% in 2007 (P < .0001), and breast MRI use rose from 0.5% to 7.0% (P < .0001). For asymptomatic patients, the use of CT/MRI of the abdomen, chest, and head was 27%, 23%, and 22%, and this slightly increased during the study period. There was a significant increase in PET/PET CT use, from 2% in 2001 to 9% in 2007 (P < .0001). There was a concomitant decrease in bone scan use from 21% in 2001 to 13% in 2007 (P < .0001). CONCLUSION Adherence to evidence-based guidelines has been substandard and the use of nonrecommended tests has persisted over the study period. The rise in PET use and attendant decrease in bone scan implicates a population receiving PET scan in lieu of bone scan for surveillance of asymptomatic metastatic disease. In an elderly population of breast cancer patients in Texas, these findings imply both underuse and overuse.
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Affiliation(s)
- Abhishek D Parmar
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0541, USA
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Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer. Breast Cancer Res Treat 2013; 142:153-63. [PMID: 24113745 DOI: 10.1007/s10549-013-2720-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 09/28/2013] [Indexed: 10/26/2022]
Abstract
Annual surveillance mammograms in older long-term breast cancer survivors are recommended, but this recommendation is based on little evidence and with no guidelines on when to stop. Surveillance mammograms should decrease breast cancer mortality by detecting second breast cancer events at an earlier stage. We examined the association between surveillance mammography beyond 5 years after diagnosis on breast cancer-specific mortality in a cohort of women aged ≥ 65 years diagnosed 1990-1994 with early stage breast cancer. Our cohort included women who survived disease free for ≥ 5 years (N = 1,235) and were followed from year 6 through death, disenrollment, or 15 years after diagnosis. Asymptomatic surveillance mammograms were ascertained through medical record review. We used Cox proportional hazards regression stratified by follow-up year to calculate the association between time-varying surveillance mammography and breast cancer-specific and other-than-breast mortality adjusting for site, stage, primary surgery type, age and time-varying Charlson Comorbidity Index. The majority (85 %) of the 1,235 5-year breast cancer survivors received ≥ 1 surveillance mammogram in years 5-9 (yearly proportions ranged from 48 to 58 %); 82 % of women received ≥ 1 surveillance mammogram in years 10-14. A total of 120 women died of breast cancer and 393 women died from other causes (average follow-up 7.3 years). Multivariable models and lasagna plots suggested a modest reduction in breast cancer-specific mortality with surveillance mammogram receipt in the preceding year (IRR 0.82, 95 % CI 0.56-1.19, p = 0.29); the association with other-cause mortality was 0.95 (95 % CI 0.78-1.17, p = 0.64). Among older breast cancer survivors, surveillance mammography may reduce breast cancer-specific mortality even after 5 years of disease-free survival. Continuing surveillance mammography in older breast cancer survivors likely requires physician-patient discussions similar to those recommended for screening, taking into account comorbid conditions and life-expectancy.
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Parmeshwar R, Margenthaler JA, Allam E, Chen L, Virgo KS, Johnson FE. Patient surveillance after initial breast cancer therapy: variation by physician specialty. Am J Surg 2013; 206:218-22. [PMID: 23870392 PMCID: PMC4896221 DOI: 10.1016/j.amjsurg.2012.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 03/11/2012] [Accepted: 05/31/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND American Society of Clinical Oncology (ASCO) guidelines recommend only office visits and mammograms as the primary modalities for patient surveillance after treatment for breast carcinoma. This study aimed to quantify differences in posttreatment surveillance among medical oncologists, radiation oncologists, and surgeons. METHODS We e-mailed a survey to the 3,245 ASCO members who identified themselves as having breast cancer as a major focus of their practices. Questions assessed the frequency of use of 12 specific surveillance modalities for 5 posttreatment years. RESULTS Of 1,012 total responses, 846 were evaluable: 5% from radiation oncologists, 70% from medical oncologists, and 10% from surgeons; 15% were unspecified. Marked variation in surveillance practices were noted within each specialty and among specialties. CONCLUSION There are notable variations in surveillance intensity. This suggests overuse or underuse or misuse of scarce medical resources.
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Affiliation(s)
- Rina Parmeshwar
- St. Louis University, St. Louis, MO
- St. Louis Veterans Affairs Medical Center, St. Louis, MO
| | | | - Emad Allam
- St. Louis University, St. Louis, MO
- St. Louis Veterans Affairs Medical Center, St. Louis, MO
| | - Ling Chen
- Washington University, St. Louis, MO
| | | | - Frank E. Johnson
- St. Louis University, St. Louis, MO
- St. Louis Veterans Affairs Medical Center, St. Louis, MO
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Houssami N, Abraham LA, Kerlikowske K, Buist DSM, Irwig L, Lee J, Miglioretti DL. Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening. Cancer Epidemiol Biomarkers Prev 2013; 22:946-61. [PMID: 23513042 DOI: 10.1158/1055-9965.epi-12-1208-t] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Women with a personal history of breast cancer (PHBC) have increased risk of an interval cancer. We aimed to identify risk factors for second (ipsilateral or contralateral) screen-detected or interval breast cancer within 1 year of screening in PHBC women. METHODS Screening mammograms from women with history of early-stage breast cancer at Breast Cancer Surveillance Consortium-affiliated facilities (1996-2008) were examined. Associations between woman-level, screen-level, and first cancer variables and the probability of a second breast cancer were modeled using multinomial logistic regression for three outcomes [screen-detected invasive breast cancer, interval invasive breast cancer, or ductal carcinoma in situ (DCIS)] relative to no second breast cancer. RESULTS There were 697 second breast cancers, of these 240 were interval cancers, among 67,819 screens in 20,941 women. In separate models for women with DCIS or invasive first cancer, first breast cancer surgery predicted all three second breast cancer outcomes (P < 0.001), and high ORs for second breast cancers (between 1.95 and 4.82) were estimated for breast conservation without radiation (relative to mastectomy). In women with invasive first breast cancer, additional variables predicted risk (P < 0.05) for at least one of the three outcomes: first-degree family history, dense breasts, longer time between mammograms, young age at first breast cancer, first breast cancer stage, and adjuvant systemic therapy for first breast cancer; and risk of interval invasive breast cancer was highest in women <40 years at first breast cancer (OR, 3.41; 1.34-8.70), those with extremely dense breasts (OR, 2.55; 1.4-4.67), and those treated with breast conservation without radiation (OR, 2.67; 1.53-4.65). CONCLUSION Although the risk of a second breast cancer is modest, our models identify risk factors for interval second breast cancer in PHBC women. IMPACT Our findings may guide discussion and evaluations of tailored breast screening in PHBC women, and incorporating this information into clinical decision-making warrants further research.
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Affiliation(s)
- Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health (A27), Sydney Medical School, University of Sydney, NSW 2006, Australia.
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Breast cancer screening: review of benefits and harms, and recommendations for developing and low-income countries. Med Oncol 2013; 30:471. [PMID: 23420062 DOI: 10.1007/s12032-013-0471-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/15/2013] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer in women worldwide. The disease remains a public health concern as recent evidence indicates that the breast cancer burden has increased mainly in developing and low-income countries (DLICs). Despite the demonstrated benefits, the debate about the real benefits and harms of breast cancer screening is ongoing. Many experts believe that the benefits of screening, in terms of reduced breast cancer mortality, outweigh the harms, whereas others think the opposite. In this review, we assess the clinical utility of available screening modalities, present evidence, overdiagnosis, cost-effectiveness, and other pertinent issues. We also examine relevant data from DLICs to underscore the barriers and challenges that impede implementation of screening strategies in those populations. We also provide recommendations concerning rational preventive strategies for breast cancer control for women in DLICs.
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McNaul D, Darke M, Garg M, Dale P. An evaluation of post-lumpectomy recurrence rates: is follow-up every 6 months for 2 years needed? J Surg Oncol 2012; 107:597-601. [PMID: 23280430 DOI: 10.1002/jso.23298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/08/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES There is currently debate about the optimal timing and frequency of mammography follow-up after breast-conserving therapy (BCT). The purpose of this study was to determine if 6-month intervals for the first 2 years following BCT offer benefit over annual screening. METHODS Three hundred ninety-nine patients who had lumpectomies between 1997 and 2009 and who were followed for at least 2 years with mammography were selected. The mammography yields for the first 2 years following BCT were compared to those of the general screening population. Also, patients were grouped as either compliant or noncompliant with the recommended 6-month intervals; Fischer's exact test was used to determine if there was a relationship between the grouping (compliant or noncompliant) and tumor recurrence. RESULTS Mammography yield was 0.94 and 2.87 per 1,000 for the first and second years, respectively, following surgery. Three hundred twenty-eight patients were categorized as compliant and 1 local recurrence was discovered in this group; 67 patients were labeled as noncompliant and 0 local recurrences were found in this group. CONCLUSIONS Mammography yield of cancer in the study population was not greater than the general population. There was no difference between the compliant and noncompliant groups regarding tumor recurrence.
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Affiliation(s)
- David McNaul
- Department of Radiology, University of Missouri, Columbia, MO, USA.
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