Variability of Postsurgical Imaging Surveillance of Breast Cancer Patients: A Nationwide Survey Study

Abstract

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.

Patterns of Breast Imaging Use Among Women with a Personal History of Breast Cancer

“…In 2018, findings from a national 8-question online survey of radiologists regarding their use of diagnostic versus screening mammography for women with a PHBC found significant variability in imaging protocols for women with a PHBC based on women's treatment (lumpectomy versus mastectomy) and facility characteristics. 31 Radiologists reported that protocols for women with lumpectomy were more likely to have a combination of diagnostic and screening examinations compared to women with mastectomy, who were more likely to have diagnostic only or screening only examinations. The most frequently reported imaging interval was every 6 months for 1-2 years (49%), with the next most common interval every 12 months for 2-5 years then screening (33%), and the least common interval was for 6 months-1 year then screening (18%).…”

Facility Variability in Examination Indication Among Women With Prior Breast Cancer: Implications and the Need for Standardization

“…We were unable to evaluate reasons behind facility coding patterns, which are likely multifactorial. Ordering provider practices may ultimately be determining indication coding; however, the BCSC does not have ordering provider information and ultimately facilities may recode examinations based on standardized coding practices [25]. We were also unable to evaluate the potential influence of factors such as geography that ties to urbanicity and access, which may be important factors driving practice variability.…”

Variability of Mammographic Imaging Surveillance in Breast Cancer Survivors

“…The mortality of breast cancer recurrence potentially can be reduced from 47% to 20% with annual mammographic surveillance [2]. A prior study in 2015 found a general variability in surveillance imaging protocols after breast-conserving surgery in practices across the United States, with the majority of surveyed practices recommending annual diagnostic mammography (DM) between 2 and 5 years before returning to annual screening mammography (SM) [3]. In 2019, the ACR updated its Appropriateness Criteria for surveillance of asymptomatic stage 1 breast cancer to the use of either SM or DM for imaging surveillance after breast-conserving surgery without an established time frame if DM is used [4].…”

“…Currently, after breast-conserving surgery, there is little to no evidencebased literature to determine which type of mammography, screening or diagnostic, is superior for surveillance imaging or the optimal duration of DM follow-up before returning to annual SM [3]. Furthermore, the lack of consistent recommendations from the NCCN and ACR for surveillance imaging after breast-conserving surgery has resulted in immense variability in clinical practice.…”

“…This variability could negatively affect patient mortality. Furthermore, the differences in out-of-pocket costs between screening and DM may result in reducing patient follow-up adherence in the setting of socioeconomic disparities [3,5,6]. Understanding the variable patterns among practice surveillance protocols could reduce confusion and allow improvement in the quality of surveillance care for patients with breast cancer and is therefore relevant.…”