Patterns of Breast Imaging Use Among Women with a Personal History of Breast Cancer
National patterns of breast imaging in women with a personal history of breast cancer (PHBC) are unknown making evaluation of annual surveillance recommendations a challenge.
To describe variation in use of mammography and breast magnetic resonance imaging (MRI) examinations beginning 6 months after diagnosis among women with PHBC in US community practice. We report on the breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.
Longitudinal study using cross-sectional data.
Breast Cancer Surveillance Consortium breast imaging facilities.
19,955 women diagnosed between 2005 and 2012 with AJCC stage 0-III incident breast cancer who had 69,386 mammograms and 3,553 breast MRI examinations from January 2005 to September 2013; median follow-up of 37.6 months (interquartile range, 22.1–60.7).
Breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.
Among women with a PHBC who received breast imaging, 89.4% underwent mammography alone, 0.8% MRI alone, and 10.3% had both mammography and MRI. About half of mammograms and MRIs were indicated for surveillance vs. diagnostic, with an increase in the proportion of surveillance exams as time from diagnosis increased (mammograms, 45.7% at 1 year to 72.2% after 5 years; MRIs, 54.8% at 1 year to 78.6% after 5 years). In the first post-diagnosis period, 32.8% of women had > 2 breast imaging examinations and of these, 65.8% were less than 6 months apart. During the first 5-year post-diagnosis, the frequency of examinations per year decreased and the interval between examinations shifted towards annual examinations.
In women with a PHBC who received post-diagnosis imaging, a third underwent multiple breast imaging examinations per year during the first 2-year post-diagnosis despite recommendations for annual exams. As time since diagnosis increases, imaging indication shifts from diagnostic to surveillance.
KEY WORDSbreast cancer cancer surveillance mammography breast magnetic resonance imaging cancer survivorship
We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. Further, we thank the study Patient Advisory Board and Stakeholder Panel for their ongoing support of this research project.
The collection of cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the US. For a full description of the BCSC, please see: http://www.bcsc-research.org/.
This study was funded by the Patient-Centered Outcomes Research Institute (PCORI) (grant number CE-1304-6656 “Comparative effectiveness of surveillance imaging modalities in breast cancer survivors”) and the National Cancer Institute (grant numbers: P01 CA154292, U54 CA163303).
Compliance with Ethical Standards
Conflict of Interest
Author Diana L. Miglioretti was a member of the Scientific Advisory Board for Hologic in 2017. Author Janie M. Lee is a consultant for General Electric Healthcare and receives a Research Grant from General Electric Healthcare. All remaining authors declare that they do not have a conflict of interest.
The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication are solely the responsibility of the authors and does not necessarily represent the official views of the Patient-Centered Outcomes Research Institute, the National Cancer Institute or the National Institutes of Health.
- 2.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. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol. 2016;34(6):611–35.CrossRefGoogle Scholar
- 3.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, American Society of Clinical Oncology. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:961–5.CrossRefGoogle Scholar
- 4.National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology - Breast Cancer. Fort Washington, PA: National Comprehensive Cancer Network (NCCN); 2016 [cited 2016 January 6]; Clinical Practice Guidelines in Oncology - Breast Cancer, Version 1.2016. Available from: http://nccn.org. Accessed 05/07/2019.
- 5.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. 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. 2010;7(1):18–27.CrossRefGoogle Scholar
- 19.Wernli KJ, Brandzel SD, Buist DSM, Bush M, DeMartini W, Ichikawa L, Haas C, Henderson LM, Johnson D, Kerlikowske K, McColgin D, Miglioretti CL, Nekhlyudov L, Onega T, Rosenberg DE. Comparative effectiveness of surveillance imaging modalities in breast cancer survivors. In press, Final research report to Patient Centered Outcomes Research Institute. 2018.Google Scholar
- 20.Breast Cancer Surveillance Consortium. 2016 [updated June 2016; Accessed 11/16/17]; Available from: http://www.bcsc-research.org/. Accessed 05/07/2019.
- 21.Ballard-Barbash R, Taplin SH, Yankaskas BC, Ernster VL, Rosenberg RD, Carney PA, Barlow WE, Geller BM, Kerlikowske K, Edwards BK, Lynch CF, Urban N, Chrvala CA, Key CR, Poplack SP, Worden JK, Kessler LG. Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. AJR Am J Roentgenol. 1997;169:1001–8.CrossRefGoogle Scholar
- 22.Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer-Verlag; 2009.Google Scholar
- 27.Gail MH, Costantino JP, Pee D, Bondy M, Newman L, Selvan M, Anderson GL, Malone KE, Marchbanks PA, McCaskill-Stevens W, Norman SA, Simon MS, Spirtas R, Ursin G, and Bernstein L. Projecting Individualized Absolute Invasive Breast Cancer Risk in African American Women. J Natl Cancer Inst. 2007;99(23):1782–1792.CrossRefGoogle Scholar
- 30.NCI-funded Breast Cancer Surveillance Consortium (P01 CA154292 and HHSN261201100031C). Downloaded 05/07/2019 from the Breast Cancer Surveillance Consortium Web site - https://tools.bcsc-scc.org/BC5yearRisk. Accessed 05/07/2019.
- 32.Center for Medicare and Medicaid Services (CMS) National Coverage Determination for Mammograms 220.4. https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?CALId=181&CalName=Prothrombin+Time+(Addition+of+ICD-9-CM+289.81%2C+Primary+Hypercoagulable+State+as+a+Covered+Indication)&ExpandComments=y&CommentPeriod=0&NCDId=186&ncdver=1&CoverageSelection=National&bc=gAAAABAAQEAAAA%3D%3D&. Accessed 05/07/2019.
- 33.American College of Radiology (ACR) Practice Parameter of Screening and Diagnostic Mammography. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Dig-Mamo.pdf. Accessed 05/07/2019.