Researchers from several U.S. medical centers have reported that women with DCIS treated with lumpectomy often fail to follow the guidelines for annual screening mammography. The details of this study appeared in the July 1, 2009 issue of the Journal of Clinical Oncology.[1]
Women who survive an initial breast cancer, including DCIS, are at increased risk for ipsilateral breast cancer if they have had breast conservation surgery. They are also at increased risk for contralateral breast cancer after lumpectomy or mastectomy. It is important that a regular screening program be carried out to detect second breast cancers in these high-risk women.
A previous study carried out by researchers affiliated with the Cancer Surveillance in HMO Administrative Project, an affiliated project of the Cancer Research Network, reported that the use of mammography among breast cancer survivors decreases over time. In another study researchers from Brigham and Women’s Hospital and the Dana Farber Cancer Center reported that only 57% of older women have annual screening mammography in the three years following treatment for localized breast cancer.
The current study evaluated rates of surveillance mammography in 3,037 women with DCIS treated by lumpectomy. They were followed for a median of five years. Follow-up mammograms were performed in 79% of women at one year from surgery. The follow-up rate was 69% at five years and 61% at 10 years. Factors associated with an increased rate of compliance at five years included women being between the ages of 60 and 69 years; use of hormonal therapy; history of radiation therapy or radiation therapy; and use of tamoxifen (Nolvadex®). Obesity was associated with a decreased rate of compliance with surveillance mammography. Annual mammograms were only performed in 34% of women followed for five years and 15% of women followed for 10 years.
Comments: Studies have shown that women with breast cancer treated with breast conserving therapy are at significant risk for contralateral and ipsilateral breast cancer for at least the 15 years (where there is reliable data). It is therefore important for women to have annual mammograms to detect early recurrences.
Reference:
[1] Nekhiyudov L, Habel LA, Achacoso NS, et al. Adherence to long-term surveillance mammography among women with ductal carcinoma in situ treated with breast-conserving surgery. Journal of Clinical Oncology. 2009;27:3211-3216.
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