Adherence to guidelines for breast surveillance in breast cancer survivors

Kathryn J Ruddy, Lindsey Sangaralingham, Rachel A. Freedman, Sarah Mougalian, Heather Neuman, Caprice Greenberg, Ahmedin Jemal, Narjust Duma, Tufia C Haddad, Valerie Lemaine, Karthik Ghosh, Tina J Hieken, Katie Hunt, Celine M Vachon, Cary Gross, Nilay D Shah

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, healthcare use, and breast imaging in the first and fifth years after surgery. Results: A total of 27,212 patients were followed for a median of 2.9 years (interquartile range, 1.8-4.6) after definitive breast cancer surgery. In year 1, 78% were screened using mammography alone, 1% using MRI alone, and 8% using both tests; 13% did not undergo either. By year 5, the proportion of the remaining cohort (n=4,790) who had no breast imaging was 19%. Older age was 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 associated with a decreased likelihood of both types of imaging. Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes. Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.

Original languageEnglish (US)
Pages (from-to)526-534
Number of pages9
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume16
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Guideline Adherence
Survivors
Breast
Breast Neoplasms
Mammography
Mastectomy
Medicare Part C
Guidelines
Survival Rate
Logistic Models
Delivery of Health Care
Drug Therapy
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Oncology

Cite this

Adherence to guidelines for breast surveillance in breast cancer survivors. / Ruddy, Kathryn J; Sangaralingham, Lindsey; Freedman, Rachel A.; Mougalian, Sarah; Neuman, Heather; Greenberg, Caprice; Jemal, Ahmedin; Duma, Narjust; Haddad, Tufia C; Lemaine, Valerie; Ghosh, Karthik; Hieken, Tina J; Hunt, Katie; Vachon, Celine M; Gross, Cary; Shah, Nilay D.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 16, No. 5, 01.05.2018, p. 526-534.

Research output: Contribution to journalArticle

Ruddy, KJ, Sangaralingham, L, Freedman, RA, Mougalian, S, Neuman, H, Greenberg, C, Jemal, A, Duma, N, Haddad, TC, Lemaine, V, Ghosh, K, Hieken, TJ, Hunt, K, Vachon, CM, Gross, C & Shah, ND 2018, 'Adherence to guidelines for breast surveillance in breast cancer survivors', JNCCN Journal of the National Comprehensive Cancer Network, vol. 16, no. 5, pp. 526-534. https://doi.org/10.6004/jnccn.2018.7001
Ruddy, Kathryn J ; Sangaralingham, Lindsey ; Freedman, Rachel A. ; Mougalian, Sarah ; Neuman, Heather ; Greenberg, Caprice ; Jemal, Ahmedin ; Duma, Narjust ; Haddad, Tufia C ; Lemaine, Valerie ; Ghosh, Karthik ; Hieken, Tina J ; Hunt, Katie ; Vachon, Celine M ; Gross, Cary ; Shah, Nilay D. / Adherence to guidelines for breast surveillance in breast cancer survivors. In: JNCCN Journal of the National Comprehensive Cancer Network. 2018 ; Vol. 16, No. 5. pp. 526-534.
@article{6ec4763bde684fb799f10c8d44621049,
title = "Adherence to guidelines for breast surveillance in breast cancer survivors",
abstract = "Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, healthcare use, and breast imaging in the first and fifth years after surgery. Results: A total of 27,212 patients were followed for a median of 2.9 years (interquartile range, 1.8-4.6) after definitive breast cancer surgery. In year 1, 78{\%} were screened using mammography alone, 1{\%} using MRI alone, and 8{\%} using both tests; 13{\%} did not undergo either. By year 5, the proportion of the remaining cohort (n=4,790) who had no breast imaging was 19{\%}. Older age was 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 associated with a decreased likelihood of both types of imaging. Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes. Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.",
author = "Ruddy, {Kathryn J} and Lindsey Sangaralingham and Freedman, {Rachel A.} and Sarah Mougalian and Heather Neuman and Caprice Greenberg and Ahmedin Jemal and Narjust Duma and Haddad, {Tufia C} and Valerie Lemaine and Karthik Ghosh and Hieken, {Tina J} and Katie Hunt and Vachon, {Celine M} and Cary Gross and Shah, {Nilay D}",
year = "2018",
month = "5",
day = "1",
doi = "10.6004/jnccn.2018.7001",
language = "English (US)",
volume = "16",
pages = "526--534",
journal = "JNCCN Journal of the National Comprehensive Cancer Network",
issn = "1540-1405",
publisher = "Cold Spring Publishing LLC",
number = "5",

}

TY - JOUR

T1 - Adherence to guidelines for breast surveillance in breast cancer survivors

AU - Ruddy, Kathryn J

AU - Sangaralingham, Lindsey

AU - Freedman, Rachel A.

AU - Mougalian, Sarah

AU - Neuman, Heather

AU - Greenberg, Caprice

AU - Jemal, Ahmedin

AU - Duma, Narjust

AU - Haddad, Tufia C

AU - Lemaine, Valerie

AU - Ghosh, Karthik

AU - Hieken, Tina J

AU - Hunt, Katie

AU - Vachon, Celine M

AU - Gross, Cary

AU - Shah, Nilay D

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, healthcare use, and breast imaging in the first and fifth years after surgery. Results: A total of 27,212 patients were followed for a median of 2.9 years (interquartile range, 1.8-4.6) after definitive breast cancer surgery. In year 1, 78% were screened using mammography alone, 1% using MRI alone, and 8% using both tests; 13% did not undergo either. By year 5, the proportion of the remaining cohort (n=4,790) who had no breast imaging was 19%. Older age was 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 associated with a decreased likelihood of both types of imaging. Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes. Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.

AB - Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods. Multinomial logistic regression was used to assess associations between patient characteristics, healthcare use, and breast imaging in the first and fifth years after surgery. Results: A total of 27,212 patients were followed for a median of 2.9 years (interquartile range, 1.8-4.6) after definitive breast cancer surgery. In year 1, 78% were screened using mammography alone, 1% using MRI alone, and 8% using both tests; 13% did not undergo either. By year 5, the proportion of the remaining cohort (n=4,790) who had no breast imaging was 19%. Older age was 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 associated with a decreased likelihood of both types of imaging. Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance breast imaging, particularly as time passes. Understanding factors associated with imaging in cancer survivors may help improve adherence to survivorship care guidelines.

UR - http://www.scopus.com/inward/record.url?scp=85046901000&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046901000&partnerID=8YFLogxK

U2 - 10.6004/jnccn.2018.7001

DO - 10.6004/jnccn.2018.7001

M3 - Article

VL - 16

SP - 526

EP - 534

JO - JNCCN Journal of the National Comprehensive Cancer Network

JF - JNCCN Journal of the National Comprehensive Cancer Network

SN - 1540-1405

IS - 5

ER -