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Adherence to NCCN Guidelines Lacking for Breast Cancer Screening

Survivors of breast cancer are not getting the recommended level of screening post-surgery, according to a newly-published study in the Journal of the National Comprehensive Cancer Network(May 2018; 16:526-534).

Current guidelines recommend an annual mammography after curative-intent treatment for breast cancer. 

Kathryn Ruddy, MD, MPH, Mayo Clinic Cancer Center (Rochester, MN), and colleagues examined post-surgery mammography rates for women with health insurance. 

Researchers assessed a total of 27,212 patients for a median of 2.9 years after breast cancer surgery, with 4790 patients remaining in the study cohort for at least 65 months. Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with non-metastatic breast cancer who had residual breast tissue after breast surgery between 2005 and 2015. 

Additionally, researchers calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of five subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, health care use, and breast imaging in the first and fifth years after surgery. 

Results of the study found that in year 1 after surgery, 78% of patients were screened using mammography alone, 1% using MRI alone, 8% using both tests, and 13% did not undergo either. By year 5, the proportion of the remaining cohort who had no breast imaging was 19%. 

Researchers acknowledged older age as a factor associated with an increased likelihood of mammography and a decreased likelihood of MRI during the first and fifth years. Black race, mastectomy, chemotherapy, and no MRI at baseline were all factors associated with a decreased likelihood of both types of imaging. 

“Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes,” authors concluded. “Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.”—Janelle Bradley

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