Half of Five-Year Survivors of Breast Cancer Are Not Receiving Recommended Post-Surgery Mammograms

While awareness continues to spread about regular mammograms to detect breast cancer, a recent study published in the Journal of the National Comprehensive Cancer Network (NCCN) found that many breast cancer survivors are not getting the proper level of screening after they have surgery for the disease.

NCCN guidelines recommend annual mammograms to detect disease recurrence, but according to the study’s findings, women — even those who had adequate health insurance — were less likely to have their once-a-year mammogram as they became long-term survivors.

“This lack of imaging follow-up represents a missed opportunity for identifying recurrent or new breast cancers among a high-risk patient subgroup,” Benjamin O. Anderson, M.D., FACS, vice chair of the NCCN Guidelines Panel for Breast Cancer, said in a statement. Anderson is professor of surgery and global health medicine at the University of Washington and Fred Hutchinson Cancer Research Center.

“Of equal importance, this finding illustrates that our health care system can fail to track sizable groups of cancer patients after completion of treatment,” he said. “The NCCN guidelines for survivorship delineate the quality-of-life issues that patients must address, which together with tests like follow-up mammograms should be a coherent and integrated survivorship plan.”

In the retrospective study, more than 27,000 patients were followed for a median 2.9 years after breast cancer surgery. The study excluded those who underwent bilateral mastectomies, since they do not need mammograms. After 65 months, 4,790 patients remained in the study cohort.

One year after cancer surgery, 13 percent of women did not undergo any breast imaging. As time went on, that number continued to increase. Five years after surgery, 19 percent of women went the year without imaging. In total, only 50 percent of the patients who were followed for five or more years had at least one mammogram per year.

The researchers on the study also found that African-American survivors were less likely than Caucasian survivors to get their yearly mammograms. This is particularly a point of interest since black women die of breast cancer at a higher rate than white women, and recurrence is a major driver for this.

According to the American Cancer Society, between the years 2009 and 2013, for every 100,000 people, 29.6 African-Americans died of the disease, compared to an average of 21 people per 100,000 in Caucasians. Limited access by black women to genetic testing could be a factor, according to the NCCN, but further research is needed to better understand why this disparity exists.

“The use of regular mammograms to detect a return of breast cancer before any symptoms appear is associated with better overall survival,” said Kathryn Ruddy, M.D., M.P.H., director of cancer survivorship for the Department of Oncology at the Mayo Clinic Cancer Center, in a release.

Ruddy was the lead author on the study and a member of the NCCN Clinical Practice Guidelines in Oncology Panel for Survivorship.

“Therefore, clinicians need to make sure that their patients are fully aware of the role these annual mammograms play in screening for new breast cancers as well as for local recurrences. Creating and implementing survivorship care plans with clear follow-up instructions may help ensure that more survivors adhere to recommended screening schedules,” she said.