The Clinical Utility and Cost of Postoperative Mammography Completed within One Year of Breast Conserving Therapy: Is it Worth It?

Abstract

Breast conserving therapy (BCT), lumpectomy followed by radiotherapy, is an effective treatment for a majority of breast cancers. According to the National Comprehensive Cancer Network, mammographic imaging should be completed at least six months after completion of radiation. This study evaluates the clinical significance and financial cost of postoperative breast imaging within one year of BCT. Patients treated with BCT between 2014 and 2016 at an academic center were identified retrospectively. The medical records were reviewed to identify the timing and type of the first imaging study after BCT. This study evaluated the clinical significance and the cost of postoperative imaging. A total of 128 patients were included into the study. Seventy-six patients received mammograms 3 to 12 months after BCT. Six of the 76 postoperative mammograms required additional imaging/intervention for a total of seven additional imaging studies and three procedures, all of which revealed benign findings. None of these patients had physical examination findings that were of clinical concern. The total cost of postoperative imaging and procedures performed less than a year after BCT was estimated to be $32,506. Postoperative imaging performed on breast cancer patients less than a year after BCT proved to be of no medical benefit and revealed no additional significant pathology. The mammographic surveillance in this study did not lead to the diagnosis of recurrent malignancy or second primary lesions and placed additional financial burden on the patient population. This study demonstrates that breast imaging within a year after BCT had no clinical impact and resulted in increased cost of care.

Direct and Indirect Costs of Breast Cancer and Associated Implications: A Systematic Review

“…Included articles were published between 2017 and 2023, with data collection spanning 2012–2020. Studies in the US ( n = 19; 36%) [ 19 – 37 ] and Canada ( n = 9; 17%) [ 38 – 46 ] made up the majority of our identified studies ( n = 28; 53%), followed collectively by the Western European countries ( n = 22; 42%). In Western Europe, most studies were in Italy ( n = 5; 9%) [ 47 – 51 ], then Spain ( n = 4; 8%) [ 52 – 55 ], France ( n = 4; 8%) [ 56 – 59 ], Netherlands ( n = 3; 6%) [ 60 – 62 ], UK ( n = 3; 6%) [ 63 – 65 ], Sweden ( n = 2; 4%) [ 66 , 67 ], and Germany ( n = 1; 2%) [ 68 ].…”

“…Of our 53 included studies, 15 (28%) reported person-level procedure costs [ 20 , 27 , 28 , 32 , 34 , 35 , 46 , 47 , 49 , 51 , 60 , 63 , 64 , 69 , 71 ]; 19 (36%) reported person-level costs over a 1-year time horizon [ 19 , 23 , 25 , 26 , 29 , 33 , 38 – 40 , 43 , 45 , 48 , 50 , 52 , 56 – 59 , 65 ]. As such, the costs from 34 (64%) studies per person for procedures and then over a 1-year time frame are presented in Table 3 and 4 , respectively, with the other included studies’ costs presented in Supplementary Excel Sheet 1.…”

“…Of the 9 (17%) studies that reported diagnosis costs [ 19 , 33 , 38 – 40 , 58 , 59 , 67 , 69 ], these studies focussed on aspects such as radiology (e.g., mammography), biopsy, laboratory tests, and genomic sequencing. Specific diagnostic procedure costs were not always reported, although Gordon et al [ 69 ] estimated the cost of genomic sequencing per procedure/person: $320.…”

Seguimiento de la paciente con diagnóstico de cáncer de mama. Revisión de la evidencia y abordaje terapéutico en el Instituto Nacional de Cancerología - Colombia

“…Con respecto a la periodicidad, aunque hay evidencia de estudios retrospectivos que sugiere que el seguimiento semestral permite una mayor identificación de recurrencias tempranas (46), esto no parece generar ningún beneficio clínico adicional (47). Sobre el inicio del seguimiento después de la cirugía conservadora, la mayoría de la literatura apunta a la ausencia de un beneficio claro con la mamografía tomada antes del año (48,49). En principio, no debería solicitarse la mamografía antes de los seis primeros meses tras la finalización de la radioterapia (21,41,49,50).…”

Mammographic Surveillance After Breast-Conserving Therapy: Impact of Digital Breast Tomosynthesis and Artificial Intelligence–Based Computer-Aided Detection

“…Worldwide, breast cancer is the most common malignancy in women and the leading cause of cancer-related death in women [1,2]. However, early detection with screening mammograms and recent advances in cancer therapy have led to a decrease in breast cancer mortality [2,3]. The surgical management of breast cancer has evolved from radical mastectomy to breast conserving surgery followed by adjuvant radiation therapy [i.e., breast conserving therapy (BCT)], which achieves equivalent disease outcomes [4][5][6][7].…”