U.S. physicians, hospitals don't adhere to same breast cancer follow-up imaging guidelines

Researchers at the University of California, San Francisco (UCSF) found that follow-up imaging for women with non-metastatic breast cancer strongly varies across the U.S. Differences are thought to be because varying common clinical practices implemented by various physician groups and hospitals.

Some metastatic breast cancer patients analyzed by the researchers never received annual mammograms, while others received full-body scans from CT, MRI or PET technologies—which can cost patients as much as $8,000 and expose low-risk individuals to unnecessary radiation, according to a study published July 13 in the JNCCN: Journal of the National Comprehensive Cancer Network.   

“With skyrocketing medical costs, patients are having to take greater and greater responsibility for out-of- pocket expenses,” said study author Benjamin Franc, MD, a professor of clinical radiology and biomedical imaging at UCSF, in a prepared statement. “These patients already have cancer, so you don’t want to induce another cancer with radiation from unnecessary imaging.” 

For their study, Franc and colleagues examined data from the Truven Health MarketScan Commercial Database of 36,045 women aged 18 to 64 who underwent surgery for cancer on one breast between 2010 and 2012. Women who received chemotherapy within 18 months after surgery were excluded from the study population to limit the group to patients with non-metastatic breast cancers, the researchers wrote. 

The team found metastatic breast cancer patients were more likely to receive recommended mammograms within 18 months of surgery if they were younger or had received radiation therapy. Additionally, the most significant predictor of whether patients received unrecommended PET imaging was the type of surgery followed by mammary serum antigen (MSA), according to the researchers. 

Other study findings included:  

  • 70.8 percent of women received at least one dedicated breast image, either a recommended mammogram or a breast MRI.
  • 31.7 percent had at least one high-cost imaging procedure and 12.5 percent had at least one PET, neither of which are recommended without a specific clinical symptom. 
  • Half of the lowest-risk patients (those who received only surgery) received the recommended mammography within 18 months of their initial treatment.
  • 64 to 70 percent of patients who had received a mastectomy and radiation, and were presumably higher risk, received some sort of breast imaging (mammography or breast MRI). 
  • Between 18 and 46 percent of patients received high-cost tomographic imaging within 18 months of their surgeries, dependent upon their geographical location.  

“Age and therapy make sense as predictors of breast imaging, but it doesn’t make sense that where you live makes a difference in whether you were likely to get a follow-up mammogram or high-cost imaging,” Franc said, according to the statement. “What’s actionable here is that we have these guidelines, but doctors aren’t following them.”