Research finds that the majority of breast cancer survivors still take part in annual surveillance mammograms, despite the exams potentially not providing much value. While the benefits of surveillance mammography for older breast cancer survivors have been quantified prospectively, "it is unlikely that mammography provides substantial benefit (and possible that mammography is harmful) to women with limited life expectancy and a low risk for in-breast cancer events," study authors wrote in the Journal of Geriatric Oncology (2022; https://doi.org/10.1016/j.jgo.2022.07.003).
Previous studies have identified that surveillance mammography is less useful in older breast cancer survivors than it is in younger breast cancer survivors, but patient preferences regarding mammography in this setting are understudied, study co-author Kathryn Ruddy, MD, an oncologist at the Mayo Clinic Comprehensive Cancer Center, told Oncology Times.
In taking on this research, Ruddy and colleagues "sought to understand current practice patterns and patient perspectives on the risks and benefits of continued mammography to inform the national discussion around this issue," she noted.
Study Details
Researchers identified 1,268 women, aged 77 and older, with a history of Stage I-III breast cancer who did not undergo bilateral mastectomy. These patients were diagnosed with cancer at least 3 years before study entry, and each had consented to be surveyed as part of the Mayo Clinic Breast Disease Registry. Patients taking part in the study were mailed one-time surveys asking about their experiences with surveillance mammography. Women with metastatic disease were excluded, with the study's primary endpoint being whether women reported at least one mammogram since breast cancer surgery.
Overall, 846 of the 1,268 women returned the survey, with 734 being deemed eligible for analysis. The median age at the time of survey was 82, and the median time since cancer diagnosis was 12 years. Ninety-three percent reported having had at least one mammogram since their initial breast cancer surgery. Seventy-nine percent reported that they had surveillance mammography annually over the prior 3 years, including 76 percent of the 491 aged 80 and older and 64 percent of the 189 patients aged 85 or older.
"Most older breast cancer survivors who have residual breast tissue are undergoing annual mammograms," the authors wrote. "Additional educational materials may be beneficial for patients and clinicians to better individualize plans for surveillance mammography in older breast cancer survivors."
With most of the study's participants reporting that they prefer to continue surveillance mammography, "it is clear that the current practice patterns are consistent with these preferences," said Ruddy. "System-related factors contributing to mammography overuse may include time constraints during office visits, limiting risk/benefit discussions."
While acknowledging that there is not a one-size-fits-all approach to breast cancer survivorship care in older survivors, Ruddy believes that "we may be overutilizing mammography in this population," if other studies confirm that more than 60 percent of breast cancer survivors aged 85 and older are still undergoing annual mammograms.
"Nuanced discussions are warranted regarding the limited value of surveillance mammography for those with shorter life expectancies," she noted.
The researchers' hypothesis heading into the study was that most older breast cancer survivors are receiving annual mammograms, "which is of low value and is also adding additional worry and cost to patients," added Dhauna Karam, MBBS, MD, a physician in the Internal Medicine Department at Mayo Clinic Health System in Albert Lea, Minn., and a co-author of the study.
She attributes the study's findings and the overuse of mammography to patient factors such as fear of cancer recurrence and the status of annual mammography as "the norm," adding that systemic factors such as computer-generated reminders and lack of time during office visits to discuss the benefits and risks of mammograms are helping to drive increased mammography use.
In terms of how these findings could affect the way that care and imaging teams approach the treatment and management of older breast cancer survivors, Karam noted the importance of individualizing survivorship care.
"Guidelines need to target primary care practitioners who are providing survivorship care more frequently," she said, "and assist them with individualized discussions on mammography use."
Mark McGraw is a contributing writer.