Women with benign breast disease after surgery ‘significantly’ less likely to follow annual imaging surveillance
Women with benign disease after breast-conserving surgery are “significantly” less likely to adhere to annual surveillance imaging, according to a new analysis published Thursday in JACR.
Black women and Medicare beneficiaries were also less likely to return for yearly diagnostic mammography, and Johns Hopkins Medicine experts believe concerted effort is needed to address this concern among underserved populations.
“We are optimistic that this study may provide evidence to support the return to annual screening mammography sooner in practices’ postsurgical surveillance protocols for breast cancer survivors and encourage more targeted retention interventions for women with benign breast diseases,” Derek Nguyen, MD, a diagnostic radiology resident with the Baltimore-based institution, and co-authors wrote Aug. 5. “This could not only result in improving the quality of individualized follow-up surveillance after [breast-conserving surgery], but also present an opportunity to close disparity gaps preventing patient follow-up with annual mammography recommendations.”
There were more than 3.8 breast cancer survivors in the U.S. as of February, with mortality rates declining over the decades due to advancements in diagnostics and treatment. But lifetime risk for local recurrence can land as high as 15% among survivors, underlining the importance of consistent imaging checkups. Variance in postsurgical surveillance protocols—due to a lack of uniform recommendations—also creates opportunities for lapses in adherence, the authors noted.
To track this concern at Hopkins, Nguyen et al. retrospectively reviewed three years of surveillance data for all patients at their institution who had breast-conserving surgery between 2011-2016. “Adherence” was defined as returning for all of the first three annual follow-up imaging exams. All told, 1,082 patients had surgery during the study period, and 715 (or 66%) were fully adherent. Black women were 1.36 times less likely to follow up annually when compared to white women, while Medicare beneficiaries were 1.84 times less likely than those with private insurance. And women with benign breast disease were “significantly” less liable to stick with annual surveillance compared to those with breast cancer.
“This is an important observation because benign breast disease is an established risk factor for breast cancer,” Nguyen and colleagues wrote. “Further exploration of the underlying causes resulting in this decrease in adherence for this specific patient population is required moving forward,” they added later.
You can read more about their results in the Journal of the American College of Radiology here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.