Surveillance for cancer recurrence in long-term young breast cancer survivors randomly selected from a statewide cancer registry
This study examined clinical breast exam (CBE) and mammography surveillance in long-term young breast cancer survivors (YBCS) and identified barriers and facilitators to cancer surveillance practices.
Data collected with a self-administered survey from a statewide, randomly selected sample of YBCS diagnosed with invasive breast cancer or ductal carcinoma in situ younger than 45 years old, stratified by race (Black vs. White/Other). Multivariate logistic regression models identified predictors of annual CBEs and mammograms.
Among 859 YBCS (n = 340 Black; n = 519 White/Other; mean age = 51.0 ± 5.9; diagnosed 11.0 ± 4.0 years ago), the majority (> 85%) reported an annual CBE and a mammogram. Black YBCS in the study were more likely to report lower rates of annual mammography and more barriers accessing care compared to White/Other YBCS. Having a routine source of care, confidence to use healthcare services, perceived expectations from family members and healthcare providers to engage in cancer surveillance, and motivation to comply with these expectations were significant predictors of having annual CBEs and annual mammograms. Cost-related lack of access to care was a significant barrier to annual mammograms.
Routine source of post-treatment care facilitated breast cancer surveillance above national average rates. Persistent disparities regarding access to mammography surveillance were identified for Black YBCS, primarily due to lack of access to routine source of care and high out-of-pocket costs.
Public health action targeting cancer surveillance in YBCS should ensure routine source of post-treatment care and address cost-related barriers. Clinical Trials Registration Number: NCT01612338.
KeywordsMammography Clinical breast exam Out-of-pocket-cost Adherence State cancer registry
Joan Such Lockhart, PhD, RN, CORLN, AOCN, CNE, ANEF, FAAN, and Sr. Rosemary Donley, PhD, APRN from Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA 15282, USA for providing support and guidance to Dr. Tarsha Jones while she completed her doctoral studies at Duquesne University School of Nursing. Jenna McLosky, CGC, Cancer Genomics Program—Michigan Department of Health and Human Services for patient and relative identification, recruitment, and assessment of eligibility.
Compliance with ethical standards
Conflict of interest
Tarsha Jones, Debra Duquette, Meghan Underhill, Kari E. Mendelsohn-Victor, Beth Anderson, Chang Ming, Kara J. Milliron, Glenn Copeland, Nancy K. Janz, Laurel L. Northouse, Sonia M. Duffy, Sofia D. Merajver, and Maria C. Katapodi declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.de Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, Forsythe L, Scoppa S, Hachey M, Rowland JH (2013) Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomark Prev 22(4):561–570. https://doi.org/10.1158/1055-9965.epi-12-1356 CrossRefGoogle Scholar
- 6.Daly B, Olopade OI (2015) A perfect storm: how tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J Clin 65(3):221–238. https://doi.org/10.3322/caac.21271 CrossRefPubMedGoogle Scholar
- 10.Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 34(6):611–635. https://doi.org/10.1200/jco.2015.64.3809 CrossRefPubMedGoogle Scholar
- 11.Evans DG, Kesavan N, Lim Y, Gadde S, Hurley E, Massat NJ, Maxwell AJ, Ingham S, Eeles R, Leach MO, Howell A, Duffy SW (2014) MRI breast screening in high-risk women: cancer detection and survival analysis. Breast Cancer Res Treat 145(3):663–672. https://doi.org/10.1007/s10549-014-2931-9 CrossRefPubMedGoogle Scholar
- 13.Buist DS, Bosco JL, Silliman RA, Gold HT, Field T, Yood MU, Quinn VP, Prout M, Lash TL (2013) Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer. Breast Cancer Res Treat 142(1):153–163. https://doi.org/10.1007/s10549-013-2720-x CrossRefPubMedGoogle Scholar
- 14.Field TS, Doubeni C, Fox MP, Buist DS, Wei F, Geiger AM, Quinn VP, Lash TL, Prout MN, Yood MU, Frost FJ, Silliman RA (2008) Under utilization of surveillance mammography among older breast cancer survivors. J Gen Intern Med 23(2):158–163. https://doi.org/10.1007/s11606-007-0471-2 CrossRefPubMedGoogle Scholar
- 16.Katz ML, Donohue KA, Alfano CM, Day JM, Herndon JE 2nd, Paskett ED (2009) Cancer surveillance behaviors and psychosocial factors among long-term survivors of breast cancer. Cancer and Leukemia Group B 79804. Cancer 115(3):480–488. https://doi.org/10.1002/cncr.24063 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Wirtz HS, Boudreau DM, Gralow JR, Barlow WE, Gray S, Bowles EJ, Buist DS (2014) Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors. Breast Cancer Res Treat 143(3):541–550. https://doi.org/10.1007/s10549-013-2816-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Howell D, Hack TF, Oliver TK, Chulak T, Mayo S, Aubin M, Chasen M, Earle CC, Friedman AJ, Green E, Jones GW, Jones JM, Parkinson M, Payeur N, Sabiston CM, Sinclair S (2012) Models of care for post-treatment follow-up of adult cancer survivors: a systematic review and quality appraisal of the evidence. J Cancer Surviv 6(4):359–371. https://doi.org/10.1007/s11764-012-0232-z CrossRefPubMedGoogle Scholar
- 28.Katapodi MC, Northouse LL, Schafenacker AM, Duquette D, Duffy SA, Ronis DL, Anderson B, Janz NK, McLosky J, Milliron KJ, Merajver SD, Duong LM, Copeland G (2013) Using a state cancer registry to recruit young breast cancer survivors and high-risk relatives: protocol of a randomized trial testing the efficacy of a targeted versus a tailored intervention to increase breast cancer screening. BMC Cancer. https://doi.org/10.1186/1471-2407-13-97 PubMedPubMedCentralGoogle Scholar
- 29.Jones T, Lockhart JS, Mendelsohn-Victor KE, Duquette D, Northouse LL, Duffy SA, Donley R, Merajver SD, Milliron KJ, Roberts JS, Katapodi MC (2016) Use of cancer genetics services in African-American young breast cancer survivors. Am J Prev Med 51(4):427–436. https://doi.org/10.1016/j.amepre.2016.03.016 CrossRefPubMedGoogle Scholar
- 30.Katapodi MC, Duquette D, Yang JJ, Mendelsohn-Victor KE, Anderson B, Nikolaidis C, Mancewicz E, Northouse LL, Duffy S, Ronis D, Milliron KJ, Probst-Hensch N, Merajver SD, Janz NK, Copeland G, Roberts SJ (2017) Recruiting families at risk for hereditary breast and ovarian cancer from a statewide cancer registry: a methodological study. Cancer Causes Control 28(3):191–201. https://doi.org/10.1007/s10552-017-0858-2 CrossRefPubMedGoogle Scholar
- 31.Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, Hantel A, Henry NL, Muss HB, Smith TJ, Vogel VG, Wolff AC, Somerfield MR, Davidson NE (2013) Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(7):961–965. https://doi.org/10.1200/jco.2012.45.9859 CrossRefPubMedGoogle Scholar
- 32.Center for Disease Control and Prevention (2015) Mammography and Breast Cancer. https://www.cdc.gov/nchs/fastats/mammography.htm. Accessed 11 Feb 2017
- 34.Risendal BC, Sedjo RL, Giuliano AR, Vadaparampil S, Jacobsen PB, Kilbourn K, Baron A, Byers T (2016) Surveillance and beliefs about follow-up care among long-term breast cancer survivors: a comparison of primary care and oncology providers. J Cancer Surviv 10(1):96–102. https://doi.org/10.1007/s11764-015-0454-y CrossRefPubMedGoogle Scholar
- 38.Stark A, Stapp R, Raghunathan A, Yan X, Kirchner HL, Griggs J, Newman L, Chitale D, Dick A (2012) Disease-free probability after the first primary ductal carcinoma in situ of the breast: a comparison between African-American and White-American women. Breast Cancer Res Treat 131(2):561–570. https://doi.org/10.1007/s10549-011-1742-5 CrossRefPubMedGoogle Scholar
- 40.López ME, Kaplan CP, Nápoles AM, Livaudais JC, Hwang ES, Stewart SL, Bloom J, Karliner L (2013) Ductal carcinoma in situ (DCIS): posttreatment follow-up care among Latina and non-Latina White women. J Cancer Surviv 7(2):219–226. https://doi.org/10.1007/s11764-012-0262-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Palmer NR, Weaver KE, Hauser SP, Lawrence JA, Talton J, Case LD, Geiger AM (2015) Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 23(11):3201–3209. https://doi.org/10.1007/s00520-015-2706-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 47.Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, Morris E, Pisano E, Schnall M, Sener S, Smith RA, Warner E, Yaffe M, Andrews KS, Russell CA (2007) American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57(2):75–89CrossRefPubMedGoogle Scholar
- 48.Mainiero MB, Lourenco A, Mahoney MC, Newell MS, Bailey L, Barke LD, D’Orsi C, Harvey JA, Hayes MK, Huynh PT, Jokich PM, Lee SJ, Lehman CD, Mankoff DA, Nepute JA, Patel SB, Reynolds HE, Sutherland ML, Haffty BG (2016) ACR appropriateness criteria breast cancer screening. J Am Coll Radiol 13(11s):R45–r49. https://doi.org/10.1016/j.jacr.2016.09.021 CrossRefPubMedGoogle Scholar
- 49.Lee CH, Dershaw DD, Kopans D, Evans P, Monsees B, Monticciolo D, Brenner RJ, Bassett L, Berg W, Feig S, Hendrick E, Mendelson E, D’Orsi C, Sickles E, Burhenne LW (2010) Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 7(1):18–27. https://doi.org/10.1016/j.jacr.2009.09.022 CrossRefPubMedGoogle Scholar
- 53.Harrison RV, Janz NK, Wolfe RA, Tedeschi PJ, Chernew M, Stross JK, Huang X, McMahon LF Jr (2003) Personalized targeted mailing increases mammography among long-term noncompliant medicare beneficiaries: a randomized trial. Med Care 41(3):375–385. https://doi.org/10.1097/01.mlr.0000053020.30060.f2 PubMedGoogle Scholar
- 55.Russell KM, Champion VL, Monahan PO, Millon-Underwood S, Zhao Q, Spacey N, Rush NL, Paskett ED (2010) Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women. Cancer Epidemiol Biomark Prev 19(1):201–210. https://doi.org/10.1158/1055-9965.epi-09-0569 CrossRefGoogle Scholar
- 56.Greenlee H, Molmenti CL, Crew KD, Awad D, Kalinsky K, Brafman L, Fuentes D, Shi Z, Tsai WY, Neugut AI, Hershman DL (2016) Survivorship care plans and adherence to lifestyle recommendations among breast cancer survivors. J Cancer Surviv 10(6):956–963. https://doi.org/10.1007/s11764-016-0541-8 CrossRefPubMedGoogle Scholar
- 61.Johnson Vickberg SM (2001) Fears about breast cancer recurrence. Cancer Pract 9(5):237–243. https://doi.org/10.1046/j.1523-5394.2001.009005237.x CrossRefPubMedGoogle Scholar
- 66.Ajzen I, Fishbein M (1980) Understanding attitudes and predicting social behaviour. Prentice Hall, Englewood CliffsGoogle Scholar