A recent study from the American Journal of Roentgenology (AJR) has found imaging surveillance follow-up appointments vary among breast cancer patients and survivors nationwide, suggesting a strong need for refinery and consistency.
According to the American Cancer Society, as of January 2014, more than 3.1 million women in the U.S. have had breast cancer. However, although breast cancer surveillance guidelines from many organizations such as the American Society of Clinical Oncology recommend an annual mammography as standard protocol, the guidelines do not specify whether a screening mammography or diagnostic mammography should be performed.
"To our knowledge, there has been no nationwide survey to examine the onset, frequency, and duration of imaging surveillance for breast cancer survivors of the disease," said lead author study Bhavika K. Patel from the department of radiology at the Mayo Clinic Arizona in Phoenix. "We aimed to survey imagers in ACR-accredited mammography facilities to determine the surveillance protocols they used and to learn how, or if, the protocols varied by associated facility characteristics."
To fully assess radiologists' use of diagnostic versus screening mammography for women with breast cancer, an eight-question online survey was distributed. More than 8,170 surveys were sent, and 849 responses were received within a 30-day time frame.
The surveys collected the following data to pinpoint any trends or patterns in surveillance practice around the U.S.:
- Demographic characteristics of the facilities (facility setting, location, practice type, screening and diagnostic mammography volume).
- Number of radiologists.
- Number of dedicated breast radiologists.
- Standard imaging protocols for patients at higher risk of breast cancer (history of lumpectomy or mastectomy, high-risk family his- tory, breast implants or augmentation, and other high-risk breast lesions).
According to study results, of the 849 surveys submitted, 79 percent of respondents recommended initial diagnostic mammography after lumpectomy, with 65 percent preferring a six-month follow up evaluations and 14 percent preferring follow up evaluations after 12 months. Furthermore, 49 percent recommended diagnostic surveillance for up to two years before a return to screening mammography and 33 percent continued diagnostic surveillance for two to five years before returning to screening, according to the study.
"For imaging after mastectomy, fifty seven percent, or respondents recommended diagnostic mammography of the unaffected breast," Patel said. "Among the 57 percent, however, 37 recommended diagnostic screening for only the first postmastectomy follow p evaluation, and the other 20 percent permanently designed patients for diagnostic mammography after mastectomy."
Additional variability found was also noted in practice setting, practice region and lead interpreting radiologist reader type. Radiologists in the West and Midwest regions of the U.S. were less likely to recommend diagnostic mammography after lumpectomy than radiologists in the South, according to the study. Also, 62 percent of survey respondents who worked in a community setting would recommend diagnostic mammography than those in academic settings.
"With the welcome news of growing population of breast cancer survivors, there is an even greater need to better define optimal surveillance mammography regimens," Patel concluded.