TY - JOUR
T1 - A National Study of the Use of Asymptomatic Systemic Imaging for Surveillance Following Breast Cancer Treatment (AFT-01)
AU - the Alliance ACS-CRP CCDR Breast Cancer Surveillance Working Group
AU - Schumacher, Jessica R.
AU - Neuman, Heather B.
AU - Chang, George J.
AU - Kozower, Benjamin D.
AU - Edge, Stephen B.
AU - Yu, Menggang
AU - Vanness, David J.
AU - Si, Yajuan
AU - Jacobs, Elizabeth A.
AU - Francescatti, Amanda B.
AU - Spears, Patricia A.
AU - Havlena, Jeffrey
AU - Adesoye, Taiwo
AU - McKellar, Daniel
AU - Winchester, David
AU - Burnside, Elizabeth S.
AU - Greenberg, Caprice C.
AU - Ballman, Karla
AU - Schrag, Deborah
AU - Partridge, Ann
AU - Ruddy, Kathryn
AU - Gavin, Patrick
AU - Green, Bettye
AU - Perlmutter, Jane
AU - Berger, Elizabeth
AU - Punglia, Rinaa
AU - Chen, Ronald
AU - Brys, Nicole
AU - Zhang, Ying
N1 - Publisher Copyright:
© 2018, Society of Surgical Oncology.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85047158820&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047158820&partnerID=8YFLogxK
U2 - 10.1245/s10434-018-6496-4
DO - 10.1245/s10434-018-6496-4
M3 - Article
C2 - 29777402
AN - SCOPUS:85047158820
SN - 1068-9265
VL - 25
SP - 2587
EP - 2595
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 9
ER -