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An evaluation of clinical follow-up in women with early stage breast cancer among physician members of the American Society of Clinical Oncology

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Summary

Routine clinical follow-up for distant metastatic disease among women with early stage breast cancer is of uncertain clinical benefit. In order to evaluate current practice patterns, we administered a mailed survey to a stratified random sample of physician members of the American Society of Clinical Oncology (ASCO) (N = 435). The survey assessed the frequency and motivation for ordering follow-up medical tests in asymptomatic postmenopausal women with stage I or II breast cancer. The response rate was 55%, distributed as 39% radiation oncologists, 32% medical oncologists, and 29% surgeons. In the first year after treatment, physicians performed, on average, one physical examination every 3 months, one blood panel (CBC, alkaline phosphatase and liver function tests) every 4 months, and one chest radiograph every 9 months. In addition, 38% of the respondents ordered CEA and 21% ordered CA 15-3 levels, 28% ordered bone scans, and less than 4% ordered CT scans, bone surveys, or bone marrow biopsies in the first year after treatment. A logistic regression analysis controlling for physician age, gender, sub-specialty, practice type, years of experience, number of breast cancer patients treated annually, geographic region, and community size, showed that surgeons were less likely to order blood tests (p < 0.001) and tumor markers (p < 0.0029) than medical oncologists in years 3 and 5 of follow-up. Compared to physicians practicing in the northeast, those from the midwest were less likely to order chest radiographs in year 3 of follow-up (p = 0.0028). Other provider characteristics had no significant effect on test ordering behavior. The results of this survey suggest that relatively uniform practice patterns in regard to the follow-up of postmenopausal women with early stage breast cancer exist among ASCO physicians.

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Authors and Affiliations

  1. Meyer L. Prentis Comprehensive Cancer Center of Metropolitan Detroit, 48201, Detroit, MI, USA

    Michael S. Simon, Michael Hoff, Mohamed Hussein, Silvana Martino & Alexander Walt

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  1. Michael S. Simon
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  2. Michael Hoff
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  3. Mohamed Hussein
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  4. Silvana Martino
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  5. Alexander Walt
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Simon, M.S., Hoff, M., Hussein, M. et al. An evaluation of clinical follow-up in women with early stage breast cancer among physician members of the American Society of Clinical Oncology. Breast Cancer Res Tr 27, 211–219 (1993). https://doi.org/10.1007/BF00665691

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