Should breast cancer survivors be excluded from, or invited to, organised mammography screening programmes?

Abstract

BackgroundThe prevalence of breast cancer in developed countries has steadily risen over recent decades. Immediate and long-term health needs of patients, including preventive care and screening services, are receiving increasing attention. A question still unresolved is whether breast cancer survivors should receive mammographic surveillance in the clinical or screening setting and, thus, whether they should be excluded from, or invited to, organised mammography screening programmes. The objective of this article is to discuss the many contradictory aspects of this matter.DiscussionProblems with mammographic surveillance of breast cancer survivors include: weak evidence of a reduction in mortality; lack of evidence in favour of one setting or the other; lack of evidence-based guidelines for the frequency and duration of surveillance; disproportionate emphasis placed on the first few years post-treatment, probably dictated by surgical and oncological priorities; a variety of screening policies, as these women are permanently or temporarily or partially excluded from many - but not all - organised screening programmes worldwide; an even greater disparity in follow-up protocols used in the clinical setting; a paucity of data on compliance to mammographic surveillance in both settings; and a difficulty in coordinating the roles of health care providers. In the future, the use of mammography in breast cancer survivors will be influenced by the inclusion of women aged > 69 years in organised screening programmes and the implementation of multidisciplinary breast units, and will probably be investigated by research activities on individual risk assessment and risk-tailored screening. In the interim, current problems can be partially alleviated with some technical solutions in screening data recording, patient flows, and care coordination.SummaryMammographic surveillance of breast cancer survivors is situated at the crossroads of numerous different specialist areas of breast cancer control and management. The solutions for current problems probably lie in some important modifications in the conventional screening procedure that are underway or under study. These developments appear to be directed towards a partial modification of the screening rationale, with an adaptation to meet the diversified breast care needs of women. The complexity of the matter constitutes a call to action for several entities to eliminate the barriers to effective research in this field.

Practices That Reduce the Latina Survival Disparity After Breast Cancer

“…Key elements for a cancer survivorship agenda are developing evidence-based approaches to highquality health care including risk tailored screening and improved interaction between patients and health care services. 24 The U.S. Centers for Disease Control and Prevention recommends establishing clinical practice guidelines for each survivorship stage and developing and disseminating public education programs capable of empowering cancer survivors to make informed decisions. 53 This study identifies a vulnerable target group who could benefit from information regarding the influence of post-diagnosis yearly mammograms on the survival disparity in the Latina population.…”

“…We examined if women received at least a yearly mammogram (consistent mammograms) after diagnosis as a time-dependent variable, since intervals shorter than 12 months are not more effective than are 1-year intervals. 24 Since many women did not have mammograms in the year of death, partially because women do not survive the entire year, we censored mammograms done in the year of death. Mammogram identification in Medicare datasets was reported 94% accurate.…”

Post-Treatment Follow-Up of Screen-Detected Breast Cancer Patients: A National Survey from Italy

“…Fifth, screen-detected breast cancer patients are permanently excluded from half of Italian screening programs. This policy, that creates a disparity across the country, is increasingly criticized (8). Particularly in those healthcare districts where FU is not actively offered, invitation to the local screening program would act as a fail-safe mechanism to prevent discontinuation of mammography FU.…”

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

“…In fact, many regional programs exclude from invitation all women previously treated for BC in a systematic manner. This practice is a matter for debate [31, 32] because only half of health care districts are served by an active follow-up service and only half of programs (re)invite these women after a variable time since the BC event (2015 GISMa survey, unpublished data ).…”