Annual Surveillance Mammography After Early-Stage Breast Cancer and Breast Cancer Mortality

Paszat, Lawrence; Sutradhar, Rinku; Gu, Sumei; Rakovitch, Eileen

doi:10.3747/co.23.3399

Cited by 7 publications

(4 citation statements)

References 26 publications

(28 reference statements)

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“…This is mainly because the benefit of annual routine surveillance is still debatable given the many disadvantages regarding false positives, recall rates and increasing the psychological burden on patients, and individual risk predictions are not widely utilised in clinical practice. Despite the guideline recommendation for annual mammography and strong consensus between many different practice guidelines, this routine surveillance is not evidence-based but rather on the assumption that early detection of recurrence reduces breast cancer mortality [ 36 , 37 ]. Furthermore, evidence of other surveillance intervals or the efficacy of different imaging modalities is lacking, whilst clinical practice is calling for personalised follow-up based on risk and patients’ needs [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Voets,

Hassink,

Veltman

et al. 2024

Breast Cancer Res Treat

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Purpose Follow-up guidelines barely diverge from a one-size-fits-all approach, even though the risk of recurrence differs per patient. However, the personalization of breast cancer care improves outcomes for patients. This study explores the variation in follow-up pathways in the Netherlands using real-world data to determine guideline adherence and the gap between daily practice and risk-based surveillance, to demonstrate the benefits of personalized risk-based surveillance compared with usual care. Methods Patients with stage I–III invasive breast cancer who received surgical treatment in a general hospital between 2005 and 2020 were selected from the Netherlands Cancer Registry and included all imaging activities during follow-up from hospital-based electronic health records. Process analysis techniques were used to map patients and activities to investigate the real-world utilisation of resources and identify the opportunities for improvement. The INFLUENCE 2.0 nomogram was used for risk prediction of recurrence. Results In the period between 2005 and 2020, 3478 patients were included with a mean follow-up of 4.9 years. In the first 12 months following treatment, patients visited the hospital between 1 and 5 times (mean 1.3, IQR 1–1) and received between 1 and 9 imaging activities (mean 1.7, IQR 1–2). Mammogram was the prevailing imaging modality, accounting for 70% of imaging activities. Patients with a low predicted risk of recurrence visited the hospital more often. Conclusions Deviations from the guideline were not in line with the risk of recurrence and revealed a large gap, indicating that it is hard for clinicians to accurately estimate this risk and therefore objective risk predictions could bridge this gap.

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Section: Discussionmentioning

confidence: 99%

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Voets,

Hassink,

Veltman

et al. 2024

Breast Cancer Res Treat

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“…By improving mammographic experiences for patients, it is hoped that uptake will increase translating into earlier diagnosis and increased survival. 14,15 Additionally, it is an important healthcare priority to reduce nonattendance rates in terms of cost savings and time. 16 This study compared previous and current mammography examinations and data showed that there was strong correlation of pain between the two time points (r ¼ 0.79, P < 0.001, Fig.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of pain experienced during successive mammography examinations in patients with a family history of breast cancer and those who have had breast cancer surgery

et al. 2020

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Introduction: To measure mammography-related pain in two groups of women undergoing regular surveillance as a baseline for future care. Methods: Following ethical approval, two hundred and forty two women aged 32e84 years (mean 54), were invited by written invitation to participate in the study. Two hundred women accepted the invitation, 100 women had a family history (FH) of breast cancer, 100 had undergone conservative surgery (FU) for breast cancer and were currently asymptomatic. A validated pain scale was used to score the participants' perceived pain before compression based on memory, immediately after compression and one week later. A series of baseline parameters were also captured including compression force, breast size/density, menstrual history and any adverse events following mammography to allow the investigation of relationships. Results: There was a strong correlation (r ¼ 0.79, p < 0.001) between previous pain scores and current pain scores, no significant correlations were found between breast size, breast density or total compression force and pain. Pain scores reduced between previous and current examinations and there was consistency in overall pain scores, despite variations in the compression forces applied. Conclusion: Physical side effects from mammography can develop and extend beyond the examination period. Patients' prior experience of pain was the only significant predictor of current pain in this study. Implications for practice: Data on past mammography experiences are essential to improve future pain outcomes. Post-mammography aftercare should be a routine feature of the examination.

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“…We adhered to Statistics Canada's recommendation not to report income quintiles in rural areas, owing to the variation of income within a single rural postal code, an approach that has been adopted by past studies. [25][26][27][28] Using the OHIP database, we identified all primary care physician and long-term follow-up clinic visits in the year before the start date of each surveillance lookback period. We categorized Johns Hopkins' Aggregated Diagnosis Groups (ADG) scores, representing measures of morbidity, 29,30 as none, low (1-5), intermediate (6)(7)(8)(9), and high (≥ 10).…”

Section: Data Sourcesmentioning

confidence: 99%

Longitudinal adherence to surveillance for late effects of cancer treatment: a population-based study of adult survivors of childhood cancer

Shuldiner,

Sutradhar,

Lau

et al. 2024

CMAJ

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Background: Adult survivors of childhood cancer are at elevated risk of morbidity and mortality compared to the general population, but their adherence to lifelong periodic surveillance is suboptimal. We aimed to examine adherence to surveillance guidelines for high-yield tests and identify risk factors for nonadherence in adult survivors of childhood cancer. Methods: In this retrospective, population-based cohort study, we used health care administrative data from Ontario, Canada, to identify adult survivors of childhood cancer diagnosed between 1986 and 2014 who were at elevated risk of therapy-related colorectal cancer, breast cancer, or cardiomyopathy. Using a Poisson regression framework, we assessed longitudinal adherence and predictors of adherence to the Children’s Oncology Group surveillance guideline. Results: Among 3241 survivors, 327 (10%), 234 (7%), and 3205 (99%) were at elevated risk for colorectal cancer, breast cancer, and cardiomyopathy, respectively. Within these cohorts, only 13%, 6%, and 53% were adherent to recommended surveillance as of February 2020. During a median follow-up of 7.8 years, the proportion of time spent adherent was 14% among survivors at elevated risk for colorectal cancer, 10% for breast cancer, and 43% for cardiomyopathy. Significant predictors of adherence varied across the risk groups, but higher comorbidity was associated with adherence to recommended surveillance. Interpretation: Survivors of childhood cancer in Ontario are rarely up to date for recommended surveillance tests. Tailored interventions beyond specialized clinics are needed to improve surveillance adherence.

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Annual Surveillance Mammography After Early-Stage Breast Cancer and Breast Cancer Mortality

Abstract: Background After treatment for early-stage breast cancer (bca), annual surveillance mammography (asm) is

Cited by 7 publications

References 26 publications

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk

A comparative study of pain experienced during successive mammography examinations in patients with a family history of breast cancer and those who have had breast cancer surgery

Longitudinal adherence to surveillance for late effects of cancer treatment: a population-based study of adult survivors of childhood cancer

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