Use of Breast Imaging After Treatment for Locoregional Breast Cancer (AFT-01)
Annual mammography is recommended after breast cancer treatment. However, studies suggest its under-utilization for Medicare patients. Utilization in the broader population is unknown, as is the role of breast magnetic resonance imaging (MRI). Understanding factors associated with imaging use is critical to improvement of adherence to recommendations.
A random sample of 9835 eligible patients receiving surgery for stages 2 and 3 breast cancer from 2006 to 2007 was selected from the National Cancer Database for primary data collection. Imaging and recurrence data were abstracted from patients 90 days after surgery to 5 years after diagnosis. Factors associated with lack of imaging were assessed using multivariable repeated measures logistic regression with generalized estimating equations. Patients were censored for death, bilateral mastectomy, new cancer, and recurrence.
Of 9835 patients, 9622, 8702, 8021, and 7457 patients were eligible for imaging at surveillance years 1 through 4 respectively. Annual receipt of breast imaging declined from year 1 (69.5%) to year 4 (61.0%), and breast MRI rates decreased from 12.5 to 5.8%. Lack of imaging was associated with age 80 years or older and age younger than 50 years, black race, public or no insurance versus private insurance, greater comorbidity, larger node-positive hormone receptor-negative tumor, excision alone or mastectomy, and no chemotherapy (p < 0.005). Receipt of breast MRI was associated with age younger than 50 years, white race, higher education, private insurance, mastectomy, chemotherapy, care at a teaching/research facility, and MRI 12 months before diagnosis (p < 0.05).
Under-utilization of mammography after breast cancer treatment is associated with sociodemographic and clinical factors, not institutional characteristics. Effective interventions are needed to increase surveillance mammography for at-risk populations.
ClinicalTrials.gov Identifier: NCT02171078.
The research reported in this article was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CE-1304-6543) and National Cancer Institute at the National Institutes of Health (NIH) grant number U10CA180821 to the Alliance for Clinical Trials in Oncology. Further funding came from the Building Interdisciplinary Research Careers in Women’s Health Scholar Program and University of Wisconsin Carbone Comprehensive Cancer Center Academic Oncologist Training Program (Neuman, NIH K12 HD055894, 5K12CA087718), and the National Cancer Institute funded Surgical Oncology Research Training Program (Adesoye, T32 CA090217).
The data used in the study are derived from a de-identified National Cancer Database file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods used or the conclusions drawn from these data by the investigator. Furthermore, the contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of PCORI or NIH. All statements in this publication, including its findings, are solely those of the authors and do not necessarily represent the views of NIH or PCORI, its Board of Governors or Methodology Committee.
- 1.Surveillance epidemiology and end results (SEER). SEER stat fact sheets: breast cancer, 2013. https://seer.cancer.gov/statfacts/html/breast.html .
- 3.Oncology NCPGi. Breast cancer screening and diagnosis, Version 1.2016. 2016. Retrieved 2 Feb 2017 at https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
- 7.Regan MM, Neven P, Giobbie-Hurder A, et al. Evaluating letrozole and tamoxifen alone and in sequence for postmenopausal women with steroid hormone receptor-positive breast cancer: the BIG 1-98 randomized clinical trial at 8.1 years median follow-up. Lancet Oncol. 2011;12:1101–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Commission on cancer. Facility oncology registry data standards. Retrieved 4 May 2016 at https://www.facs.org/~/media/files/quality programs/cancer/ncdb/fords 2016.ashx.