A National Study of the Use of Asymptomatic Systemic Imaging for Surveillance Following Breast Cancer Treatment (AFT-01)
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Although not guideline recommended, studies suggest 50% of locoregional breast cancer patients undergo systemic imaging during follow-up, prompting its inclusion as a Choosing Wisely measure of potential overuse. Most studies rely on administrative data that cannot delineate scan intent (prompted by signs/symptoms vs. asymptomatic surveillance). This is a critical gap as intent is the only way to distinguish overuse from appropriate care.
Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent.
A stage-stratified random sample of 10 women with stage II–III breast cancer in 2006–2007 was selected from each of 1217 Commission on Cancer-accredited facilities, for a total of 10,838 patients. Registrars abstracted scan type (computed tomography [CT], non-breast magnetic resonance imaging, bone scan, positron emission tomography/CT) and intent (cancer-related vs. not, asymptomatic surveillance vs. not) from medical records for 5 years post-diagnosis. Data were merged with each patient’s corresponding National Cancer Database record, containing sociodemographic and tumor/treatment information.
Of 10,838 women, 30% had one or more, and 12% had two or more, systemic surveillance scans during a 4-year follow-up period. Patients were more likely to receive surveillance imaging in the first follow-up year (lower proportions during subsequent years) and if they had estrogen receptor/progesterone receptor-negative tumors.
Locoregional breast cancer patients undergo asymptomatic systemic imaging during follow-up despite guidelines recommending against it, but at lower rates than previously reported. Providers appear to use factors that confer increased recurrence risk to tailor decisions about systemic surveillance imaging, perhaps reflecting limitations of data on which current guidelines are based.
ClinicalTrials.gov Identifier: NCT02171078.
An abstract based on these findings was selected for a podium presentation at the 2016 Academy Health Annual Research Meeting, Boston, MA, USA, June 2016. The authors wish to thank the cancer registrars and cancer physician liaisons at all participating Commission on Cancer-accredited facilities and National Cancer Database staff for their contributions and dedication to this project. Other members of the Alliance/American College of Surgeons Clinical Research Program (ACS-CRP) Cancer Care Delivery Research PCORI Breast Cancer Surveillance Working Group include Karla Ballman, PhD; Deborah Schrag, MD, MPH; Ann Partridge, MD, MPH; Kathryn Ruddy, MD; Patrick Gavin, RPh; Bettye Green, RN; Jane Perlmutter, PhD, MBA; Elizabeth Berger, MD; Rinaa Punglia, MD, MPH; Ronald Chen, MD, MPH; Nicole Brys, MPH; and Ying Zhang.
Research reported in this manuscript was funded through a Patient-Centered Outcomes Research Institute (PCORI) award (CE-1304-6543) and the National Cancer Institute at the National Institutes of Health (NIH; Grant number U10CA180821 to the Alliance for Clinical Trials in Oncology). Further funding came from the Building Interdisciplinary Research Careers in Women’s Health Scholar Program and University of Wisconsin Carbone Comprehensive Cancer Center Academic Oncologist Training Program (Neuman; NIH K12 HD055894, 5K12CA087718), and the National Cancer Institute-funded Surgical Oncology Research Training Program (Adesoye; T32CA090217).
The data used in this study are derived from a de-identified National Cancer Database file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. Furthermore, the contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the NIH or the PCORI, its Board of Governors or Methodology Committee.
Jessica R. Schumacher, Heather B. Neuman, George J. Chang, Benjamin D. Kozower, Stephen Edge, Menggang Yu, David J. Vanness, Yajuan Si, Elizabeth A. Jacobs, Amanda B. Francescatti, Patricia Spears, Jeffrey Havlena, Taiwo Adesoye, Daniel McKellar, David Winchester, Elizabeth Burnside, and Caprice C. Greenberg have no conflicts of interest to declare.
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