Utility of Clinical Breast Examinations in Detecting Local–Regional Breast Events After Breast-Conservation in Women with a Personal History of High-Risk Breast Cancer
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Although breast cancer follow-up guidelines emphasize the importance of clinical examinations, prior studies suggest a small fraction of local–regional events occurring after breast conservation are detected by examination alone. Our objective was to examine how local–regional events are detected in a contemporary, national cohort of high-risk breast cancer survivors.
A stage-stratified sample of stage II/III breast cancer patients diagnosed in 2006–2007 (n = 11,099) were identified from 1217 facilities within the National Cancer Data Base. Additional data on local–regional and distant breast events, method of event detection, imaging received, and mortality were collected. We further limited the cohort to patients with breast conservation (n = 4854). Summary statistics describe local–regional event rates and detection method.
Local–regional events were detected in 5.5 % (n = 265) of patients. Eighty-three percent were ipsilateral or contralateral in-breast events, and 17 % occurred within ipsilateral lymph nodes. Forty-eight percent of local–regional events were detected on asymptomatic breast imaging, 29 % by patients, and 10 % on clinical examination. Overall, 0.5 % of the 4854 patients had a local–regional event detected on examination. Examinations detected a higher proportion of lymph node events (8/45) compared with in-breast events (18/220). No factors were associated with method of event detection.
Clinical examinations, as an adjunct to screening mammography, have a modest effect on local–regional event detection. This contradicts current belief that examinations are a critical adjunct to mammographic screening. These findings can help to streamline follow-up care, potentially improving follow-up efficiency and quality.
KeywordsBreast Cancer Breast Cancer Survivor Screening Mammography Digital Mammography Digital Breast Tomosynthesis
The statements presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee. This study would not have been possible without the commitment of the CoC, and particularly the dedication of the Registrars and Cancer Liaison Physicians of the participating CoC institutions. Members of the Alliance ACS: Clinical Research Program Cancer Care Delivery Research PCORI Breast Cancer Surveillance Working Group include Caprice Greenberg, MD, MPH; Heather Neuman, MD, MS; Taiwo Adesoye, MD; Nicole Brys, MPH; Jeffrey Havlena; Jessica Schumacher, PhD; Menggang Yu, PhD; Yajuan Si, PhD; Ying Zhang; Elizabeth Jacobs, MD, MAPP; David Vanness, PhD; Elizabeth Burnside, MD, MPH, MS; Karla Ballman, PhD; Patrick Gavin, RPh; Bettye Green, RN; Jane Perlmutter, PhD, MBA; Patricia Spears; Stephen Edge MD, FACS; David Winchester, MD, FACS; Amanda Francescatti; Elizabeth Berger, MD; Rinaa Punglia, MD, MPH; Deborah Schrag, MD, MPH; Ann Partridge, MD, MPH; Ronald Chen, MD, MPH; Kathryn Ruddy, MD; George Chang, MD; and Benjamin Kozower, MD, MPH.
Research reported in this manuscript was funded through a PCORI Award (CE-1304-6543). Further funding came from the Building Interdisciplinary Research Careers in Women’s Health Scholar Program (NIH K12 HD055894).
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Conflicts of Interest
Dr. Greenberg has an advisory role for Johnson and Johnson, and has received research funding from Covidien (unrelated work). Dr. Vanness receives consulting fees from Evidera. Heather Neuman, Jessica Schumacher, Amanda Francescatti, Taiwo Adesoye, Stephen Edge, Elizabeth Burnside, Menggang Yu, Yajuan Si, Dan McKellar, and David Winchester have no conflicts of interest to declare.
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