One-Third of People Diagnosed With Breast Cancer Not Getting Appropriate Follow-Up Imaging

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After breast cancer treatment is completed, you and your doctor will work together to come up with a schedule of follow-up visits and exams that is right for your situation.

If you had a lumpectomy followed by radiation, you’ll have a mammogram of the affected breast 6 months after radiation is completed, and then have a mammogram of both breasts every year. If you had a mastectomy, you’ll have a mammogram of the remaining breast every year. If you’re considered to have a high risk of developing another breast cancer, whether due to strong family history or a genetic mutation, such as a BRCA1 or BRCA2 mutation, your doctor may recommend breast MRI in addition to yearly mammograms.

Still, a study suggests that nearly 33% of women diagnosed with breast cancer aren’t receiving an annual mammogram after treatment.

The research was presented at the 2016 Annual Clinical Congress of the American College of Surgeons on Oct. 19, 2016.

To do the study, the researchers looked at information on 9,622 women who had surgery to treat stage II or stage III breast cancer from 2006 to 2007. About half the women were younger than 60. The information was in the National Cancer Database, which is jointly sponsored by the American College of Surgeons and the American Cancer Society.

The researchers looked at the women’s records from the time they were diagnosed to 5 years after diagnosis and looked at whether the women had:

  • imaging
  • a cancer recurrence
  • a new cancer diagnosis
  • died

The researchers classified why the imaging was done into one of two categories:

  • evaluation of a new symptom
  • screening imaging with no symptoms

The researchers found that annual screening imaging dropped 8% from the first year, when 66% percent of the women had an annual screening mammogram, to the fourth year, when 58% of the women had a screening mammogram. The results also showed that only about 10% of the women had a breast MRI.

"The most striking finding is that more than 30% of women don't even get surveillance breast imaging in the first place," said Caprice Greenberg. M.D., of the University of Wisconsin School of Medicine and Public Health, who led the study. "For some reason, we are not plugging them into follow-up surveillance from the outset. We also see that there are some disparities in the use of mammograms after the treatment of breast cancer."

Women were less likely to have recommended follow-up imaging if they:

  • were younger
  • were black
  • had public or no health insurance
  • had more advanced-stage cancer
  • had worse overall health
  • had mastectomy instead of lumpectomy and radiation
  • did not receive systemic therapy such as chemotherapy or hormonal therapy

"The critical story here is that if women start off their follow-up care receiving guideline-recommended imaging, they're likely to continue to receive that imaging over time. Women who don't receive imaging in that first follow-up year are not likely to receive recommended surveillance breast imaging longer-term," said study co-author Jessica Schumacher, Ph.D. "The bulk of the disparity seems to occur in that first year of follow up, so it's really important to think about what we might be able to do in that timeframe to make sure women get guideline-recommended breast imaging."

This study echoes the results of other studies that suggest that most cancer survivors are on their own when it comes to follow-up care, both long- and short-term.

Because of treatments they’ve received, many breast cancer survivors have a higher risk of developing other diseases as they age, including high blood pressure, heart disease, and osteoporosis. To make sure breast cancer survivors are regularly screened for these and other diseases that they may be at higher risk for, experts have developed the idea of survivorship care planning.

The Institute of Medicine, an arm of the National Academy of Sciences, published a report in 2006 recommending that all cancer survivors receive a survivorship care plan after they were done with treatment. The survivorship care plan should include a written treatment summary and a personalized follow-up plan developed by the patient’s oncologist. The Institute of Medicine report also recommends that survivorship care planning include discussions about which doctors (oncologist, primary care doctor, other specialists) should be seen for specific follow-up care.

After your main breast cancer treatment is done, it’s important to focus on what’s now most important: your good health. You have to make sure you get the best ongoing care and live your best life. If you’ve finished breast cancer treatment and your oncologist hasn’t talked to you about a survivorship care plan, it’s a good idea to bring it up at your next appointment. Here are some questions you may want to ask your oncologist:

  • Can I get a survivorship care plan in writing that explains all the medical issues I need to consider and tells me which screening tests I need and when I should have them?
  • Which doctor should I see for each medical issue?
  • If your oncologist recommends that you see a specialist -- a cardiologist for example -- and you’ve never seen one before, you may want to ask for a referral to a specific doctor.
  • If there is anything in your survivorship care plan that you don’t understand, ask your doctor or nurse to explain it.

It’s also a good idea to talk to your primary care doctor about your survivorship care plan and ask which parts of it she or he will be responsible for.

There’s only one of you and you deserve the best care possible, both during and after cancer treatment. Because the idea of survivorship care plans is relatively new, you may have to advocate for yourself to make sure you that get a written plan.



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