Jessica R Schumacher1, Heather B Neuman1, George J Chang2, Benjamin D Kozower3, Stephen B Edge4, Menggang Yu5, David J Vanness6, Yajuan Si5,6, Elizabeth A Jacobs7, Amanda B Francescatti8, Patricia A Spears9, Jeffrey Havlena1, Taiwo Adesoye1, Daniel McKellar8, David Winchester8, Elizabeth S Burnside10, Caprice C Greenberg11. 1. Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA. 2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. 4. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA. 5. Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA. 6. Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA. 7. Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA. 8. American College of Surgeons, Commission on Cancer, Chicago, IL, USA. 9. Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, USA. 10. Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA. 11. Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA. greenberg@surgery.wisc.edu.
Abstract
BACKGROUND: 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. OBJECTIVE: Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: Although not guideline recommended, studies suggest 50% of locoregional breast cancerpatients 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. OBJECTIVE: Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent. METHODS: 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. RESULTS: 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. CONCLUSIONS: Locoregional breast cancerpatients 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.
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