Researchers from Brigham and Women’s Hospital and the Dana Farber Cancer Center have reported that only 57% of older women have annual screening mammography in the 3 years following treatment for localized breast cancer.[1] In a separate report researchers from the Lombardi Comprehensive Cancer Center reported that despite heavy use of medical services only 71% of women treated for localized breast cancer have a surveillance mammogram in the first 18 months after treatment.[2] These two studies appeared in the January 1, 2006, issue of the Journal of Clinical Oncology.

Surveillance mammograms are recommended on an annual basis for women treated for stage I-III breast cancer with either lumpectomy or mastectomy. However, there have been few studies evaluating how well this recommendation is carried out in practice.

The Boston study looked at data from Surveillance, Epidemiology, and End Results-Medicare data on 44,511 women 65 years of age or older who were treated for stage I-II breast cancer between 1992 and 1999. They then looked at the frequency of surveillance mammography during months 7-18, 19-30 and 31-32 after treatment.

These researchers reported that 77.6% of women had a mammogram performed in months 7-18 and 56.7% had an annual mammogram for 3 consecutive years after treatment. The frequency of surveillance mammograms declined with increasing age, were less frequent in black women, and less frequent in women with a mastectomy versus a lumpectomy. Surveillance mammography was more likely to be performed if care was given by a subspecialist such as a medical or radiation oncologist. There was also an improvement in the frequency of surveillance mammography with later years of study.

The Georgetown study looked at the use of health services in 418 women treated for stage I-II breast cancer and found a high rate of health care usage in the first year after treatment. However, during the first year after treatment only 61.9% received a screening mammogram in the first 12 months and 71% in first 18 months following treatment. Screening rates were higher for women receiving lumpectomy versus those receiving a mastectomy.

There were other interesting aspects to this study. They found that the rates of mastectomy varied from a high of 49% in Kansas to a low of 13.5% in Washington, D.C. This cohort of women had an average of 14.4 visits to medical providers in the year of study with only 18% being for psychological reasons. Women less than 50 years of age and black women had fewer than average visits to health care providers.

Comments: These 2 reports suggest room for improvement in mammography surveillance after treatment of localized breast cancer. The variability of treatment patterns (lumpectomy vs. mastectomy) in the United States is still striking. There still is a disparity of treatment for black women.

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