Women treated for DCIS are not obtaining regular surveillance mammograms

NEW YORK (Reuters Health) - In women who have been treated for ductal carcinoma in situ (DCIS), compliance with mammography surveillance guidelines tends to decline over time, despite their higher-than-average risks for recurrence and contralateral breast cancer.

This finding, published online ahead of print in the Journal of Clinical Oncology, comes from a study of more than 3,000 women treated with breast-conserving surgery for DCIS between 1990 and 2001 and followed for a median of 4.8 years.

The research team, headed by Dr. Larissa Nekhlyudov of Harvard Medical School in Boston, note that up to 20% of women with DCIS will have a recurrence within 5 years, and they have a 2 to 4 times higher risk of contralateral breast cancer. Therefore, annual surveillance mammography is generally recommended.

The investigators found that rates of surveillance mammograms were 79% during the first year of follow-up, 69% in the fifth year, and 61% in the tenth year. Furthermore, only 34% of women observed for 5 years and only 15% of those observed for 10 years had annual surveillance mammograms.

The investigators also found that among patients observed for 5 years, those more likely to have surveillance mammograms were diagnosed between the ages of 60 to 69 years (OR 1.72), users of menopausal hormone therapy at diagnosis (OR, 1.26), and treated with adjuvant radiation alone (OR, 1.28) or with tamoxifen (OR, 1.61). Obese women were less likely to have surveillance mammograms (OR, 0.70). The findings were similar in women followed for 10 years, the authors report.

"Because DCIS is considered to be a precursor to invasive breast cancer, it is particularly important for women to receive surveillance for recurrences of DCIS and/or newly diagnosed invasive breast cancer," the authors conclude. "Monitoring efforts should be adopted by health care delivery sites to ensure that surveillance occurs after breast conserving surgery for DCIS."

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