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. 2019 Oct;34(10):2098-2106.
doi: 10.1007/s11606-019-05181-6. Epub 2019 Aug 13.

Patterns of Breast Imaging Use Among Women with a Personal History of Breast Cancer

Louise M Henderson  1 , Laura Ichikawa  2 , Diana S M Buist  2 , Janie M Lee  3 , Mary Bush  2 , Dianne Johnson  2 , Tracy Onega  4 , Larissa Nekhlyudov  5 , Karla Kerlikowske  6   7 , Diana L Miglioretti  2   8 , Brian L Sprague  9 , Karen J Wernli  2
Affiliations

Patterns of Breast Imaging Use Among Women with a Personal History of Breast Cancer

Louise M Henderson et al. J Gen Intern Med. 2019 Oct.

Abstract

Background: National patterns of breast imaging in women with a personal history of breast cancer (PHBC) are unknown making evaluation of annual surveillance recommendations a challenge.

Objective: To describe variation in use of mammography and breast magnetic resonance imaging (MRI) examinations beginning 6 months after diagnosis among women with PHBC in US community practice. We report on the breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.

Design: Longitudinal study using cross-sectional data.

Setting: Breast Cancer Surveillance Consortium breast imaging facilities.

Participants: 19,955 women diagnosed between 2005 and 2012 with AJCC stage 0-III incident breast cancer who had 69,386 mammograms and 3,553 breast MRI examinations from January 2005 to September 2013; median follow-up of 37.6 months (interquartile range, 22.1-60.7).

Main measures: Breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.

Key results: Among women with a PHBC who received breast imaging, 89.4% underwent mammography alone, 0.8% MRI alone, and 10.3% had both mammography and MRI. About half of mammograms and MRIs were indicated for surveillance vs. diagnostic, with an increase in the proportion of surveillance exams as time from diagnosis increased (mammograms, 45.7% at 1 year to 72.2% after 5 years; MRIs, 54.8% at 1 year to 78.6% after 5 years). In the first post-diagnosis period, 32.8% of women had > 2 breast imaging examinations and of these, 65.8% were less than 6 months apart. During the first 5-year post-diagnosis, the frequency of examinations per year decreased and the interval between examinations shifted towards annual examinations.

Conclusion: In women with a PHBC who received post-diagnosis imaging, a third underwent multiple breast imaging examinations per year during the first 2-year post-diagnosis despite recommendations for annual exams. As time since diagnosis increases, imaging indication shifts from diagnostic to surveillance.

Keywords: breast cancer; breast magnetic resonance imaging; cancer surveillance; cancer survivorship; mammography.

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Conflict of interest statement

Author Diana L. Miglioretti was a member of the Scientific Advisory Board for Hologic in 2017. Author Janie M. Lee is a consultant for General Electric Healthcare and receives a Research Grant from General Electric Healthcare. All remaining authors declare that they do not have a conflict of interest.

Figures

Fig. 1
Fig. 1
Observed frequency of mammography (panel a) and MRI (panel b) examinations by the number of years post-diagnosis and months since prior examination in women with a personal history of breast cancer. Blue bars represent exams with another exam in the prior 3 months, orange bars represent exams with another exam in the prior 3 to less than 6 months, light gray bars represent exams with another exam in the prior 6 to less than 9 months, yellow bars represent exams with another exam in the prior 9 to less than 12 months, green bars represent exams with another exam in the prior 12 to less than 24 months, and dark gray bars represent exams with another exam in more than 24 months. a Proportion of mammograms by months since prior examination and time since breast cancer diagnosis, Breast Cancer Surveillance Consortium 2005–2013. b Proportion of MRI examinations by months since prior examination and time since breast cancer diagnosis, Breast Cancer Surveillance Consortium 2005–2013. Figure 1 contains of poor quality of text.Please let me know if you need me to resubmit the figures.
See this image and copyright information in PMC

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