A National Study of the Use of Asymptomatic Systemic Imaging for Surveillance Following Breast Cancer Treatment (AFT-01)

The Alliance Acs-Crp Ccdr Breast Cancer Surveillance Working Group, Jessica R. Schumacher, Heather B. Neuman, George J. Chang, Benjamin D. Kozower, Stephen B. Edge, Menggang Yu, David J. Vanness, Yajuan Si, Elizabeth A. Jacobs, Amanda B. Francescatti, Patricia A. Spears, Jeffrey Havlena, Taiwo Adesoye, Daniel McKellar, David Winchester, Elizabeth S. Burnside, Caprice C. Greenberg, Karla Ballman, Deborah Schrag & 10 others Ann Partridge, Kathryn Ruddy, Patrick Gavin, Bettye Green, Jane Perlmutter, Elizabeth Berger, Rinaa Punglia, Ronald Chen, Nicole Brys, Ying Zhang

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Abstract

Background: Although not guideline recommended, studies suggest 50% of locoregional breast cancer patients undergo systemic imaging during follow-up, prompting its inclusion as a Choosing Wisely measure of potential overuse. Most studies rely on administrative data that cannot delineate scan intent (prompted by signs/symptoms vs. asymptomatic surveillance). This is a critical gap as intent is the only way to distinguish overuse from appropriate care. Objective: Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent. Methods: A stage-stratified random sample of 10 women with stage II–III breast cancer in 2006–2007 was selected from each of 1217 Commission on Cancer-accredited facilities, for a total of 10,838 patients. Registrars abstracted scan type (computed tomography [CT], non-breast magnetic resonance imaging, bone scan, positron emission tomography/CT) and intent (cancer-related vs. not, asymptomatic surveillance vs. not) from medical records for 5 years post-diagnosis. Data were merged with each patient’s corresponding National Cancer Database record, containing sociodemographic and tumor/treatment information. Results: Of 10,838 women, 30% had one or more, and 12% had two or more, systemic surveillance scans during a 4-year follow-up period. Patients were more likely to receive surveillance imaging in the first follow-up year (lower proportions during subsequent years) and if they had estrogen receptor/progesterone receptor-negative tumors. Conclusions: Locoregional breast cancer patients undergo asymptomatic systemic imaging during follow-up despite guidelines recommending against it, but at lower rates than previously reported. Providers appear to use factors that confer increased recurrence risk to tailor decisions about systemic surveillance imaging, perhaps reflecting limitations of data on which current guidelines are based. ClinicalTrials.gov Identifier: NCT02171078.

LanguageEnglish (US)
Pages1-9
Number of pages9
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - May 17 2018

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Breast Neoplasms
Guidelines
Neoplasms
Therapeutics
Progesterone Receptors
Estrogen Receptors
Signs and Symptoms
Medical Records
Tomography
Magnetic Resonance Imaging
Databases
Bone and Bones
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Oncology

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A National Study of the Use of Asymptomatic Systemic Imaging for Surveillance Following Breast Cancer Treatment (AFT-01). / The Alliance Acs-Crp Ccdr Breast Cancer Surveillance Working Group.

In: Annals of Surgical Oncology, 17.05.2018, p. 1-9.

Research output: Contribution to journalArticle

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title = "A National Study of the Use of Asymptomatic Systemic Imaging for Surveillance Following Breast Cancer Treatment (AFT-01)",
abstract = "Background: Although not guideline recommended, studies suggest 50{\%} of locoregional breast cancer patients undergo systemic imaging during follow-up, prompting its inclusion as a Choosing Wisely measure of potential overuse. Most studies rely on administrative data that cannot delineate scan intent (prompted by signs/symptoms vs. asymptomatic surveillance). This is a critical gap as intent is the only way to distinguish overuse from appropriate care. Objective: Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent. Methods: A stage-stratified random sample of 10 women with stage II–III breast cancer in 2006–2007 was selected from each of 1217 Commission on Cancer-accredited facilities, for a total of 10,838 patients. Registrars abstracted scan type (computed tomography [CT], non-breast magnetic resonance imaging, bone scan, positron emission tomography/CT) and intent (cancer-related vs. not, asymptomatic surveillance vs. not) from medical records for 5 years post-diagnosis. Data were merged with each patient’s corresponding National Cancer Database record, containing sociodemographic and tumor/treatment information. Results: Of 10,838 women, 30{\%} had one or more, and 12{\%} had two or more, systemic surveillance scans during a 4-year follow-up period. Patients were more likely to receive surveillance imaging in the first follow-up year (lower proportions during subsequent years) and if they had estrogen receptor/progesterone receptor-negative tumors. Conclusions: Locoregional breast cancer patients undergo asymptomatic systemic imaging during follow-up despite guidelines recommending against it, but at lower rates than previously reported. Providers appear to use factors that confer increased recurrence risk to tailor decisions about systemic surveillance imaging, perhaps reflecting limitations of data on which current guidelines are based. ClinicalTrials.gov Identifier: NCT02171078.",
author = "{The Alliance Acs-Crp Ccdr Breast Cancer Surveillance Working Group} and Schumacher, {Jessica R.} and Neuman, {Heather B.} and Chang, {George J.} and Kozower, {Benjamin D.} and Edge, {Stephen B.} and Menggang Yu and Vanness, {David J.} and Yajuan Si and Jacobs, {Elizabeth A.} and Francescatti, {Amanda B.} and Spears, {Patricia A.} and Jeffrey Havlena and Taiwo Adesoye and Daniel McKellar and David Winchester and Burnside, {Elizabeth S.} and Greenberg, {Caprice C.} and Karla Ballman and Deborah Schrag and Ann Partridge and Kathryn Ruddy and Patrick Gavin and Bettye Green and Jane Perlmutter and Elizabeth Berger and Rinaa Punglia and Ronald Chen and Nicole Brys and Ying Zhang",
year = "2018",
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journal = "Annals of Surgical Oncology",
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T1 - A National Study of the Use of Asymptomatic Systemic Imaging for Surveillance Following Breast Cancer Treatment (AFT-01)

AU - The Alliance Acs-Crp Ccdr Breast Cancer Surveillance Working Group

AU - Schumacher, Jessica R.

AU - Neuman, Heather B.

AU - Chang, George J.

AU - Kozower, Benjamin D.

AU - Edge, Stephen B.

AU - Yu, Menggang

AU - Vanness, David J.

AU - Si, Yajuan

AU - Jacobs, Elizabeth A.

AU - Francescatti, Amanda B.

AU - Spears, Patricia A.

AU - Havlena, Jeffrey

AU - Adesoye, Taiwo

AU - McKellar, Daniel

AU - Winchester, David

AU - Burnside, Elizabeth S.

AU - Greenberg, Caprice C.

AU - Ballman, Karla

AU - Schrag, Deborah

AU - Partridge, Ann

AU - Ruddy, Kathryn

AU - Gavin, Patrick

AU - Green, Bettye

AU - Perlmutter, Jane

AU - Berger, Elizabeth

AU - Punglia, Rinaa

AU - Chen, Ronald

AU - Brys, Nicole

AU - Zhang, Ying

PY - 2018/5/17

Y1 - 2018/5/17

N2 - Background: Although not guideline recommended, studies suggest 50% of locoregional breast cancer patients undergo systemic imaging during follow-up, prompting its inclusion as a Choosing Wisely measure of potential overuse. Most studies rely on administrative data that cannot delineate scan intent (prompted by signs/symptoms vs. asymptomatic surveillance). This is a critical gap as intent is the only way to distinguish overuse from appropriate care. Objective: Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent. Methods: A stage-stratified random sample of 10 women with stage II–III breast cancer in 2006–2007 was selected from each of 1217 Commission on Cancer-accredited facilities, for a total of 10,838 patients. Registrars abstracted scan type (computed tomography [CT], non-breast magnetic resonance imaging, bone scan, positron emission tomography/CT) and intent (cancer-related vs. not, asymptomatic surveillance vs. not) from medical records for 5 years post-diagnosis. Data were merged with each patient’s corresponding National Cancer Database record, containing sociodemographic and tumor/treatment information. Results: Of 10,838 women, 30% had one or more, and 12% had two or more, systemic surveillance scans during a 4-year follow-up period. Patients were more likely to receive surveillance imaging in the first follow-up year (lower proportions during subsequent years) and if they had estrogen receptor/progesterone receptor-negative tumors. Conclusions: Locoregional breast cancer patients undergo asymptomatic systemic imaging during follow-up despite guidelines recommending against it, but at lower rates than previously reported. Providers appear to use factors that confer increased recurrence risk to tailor decisions about systemic surveillance imaging, perhaps reflecting limitations of data on which current guidelines are based. ClinicalTrials.gov Identifier: NCT02171078.

AB - Background: Although not guideline recommended, studies suggest 50% of locoregional breast cancer patients undergo systemic imaging during follow-up, prompting its inclusion as a Choosing Wisely measure of potential overuse. Most studies rely on administrative data that cannot delineate scan intent (prompted by signs/symptoms vs. asymptomatic surveillance). This is a critical gap as intent is the only way to distinguish overuse from appropriate care. Objective: Our aim was to assess surveillance systemic imaging post-breast cancer treatment in a national sample accounting for scan intent. Methods: A stage-stratified random sample of 10 women with stage II–III breast cancer in 2006–2007 was selected from each of 1217 Commission on Cancer-accredited facilities, for a total of 10,838 patients. Registrars abstracted scan type (computed tomography [CT], non-breast magnetic resonance imaging, bone scan, positron emission tomography/CT) and intent (cancer-related vs. not, asymptomatic surveillance vs. not) from medical records for 5 years post-diagnosis. Data were merged with each patient’s corresponding National Cancer Database record, containing sociodemographic and tumor/treatment information. Results: Of 10,838 women, 30% had one or more, and 12% had two or more, systemic surveillance scans during a 4-year follow-up period. Patients were more likely to receive surveillance imaging in the first follow-up year (lower proportions during subsequent years) and if they had estrogen receptor/progesterone receptor-negative tumors. Conclusions: Locoregional breast cancer patients undergo asymptomatic systemic imaging during follow-up despite guidelines recommending against it, but at lower rates than previously reported. Providers appear to use factors that confer increased recurrence risk to tailor decisions about systemic surveillance imaging, perhaps reflecting limitations of data on which current guidelines are based. ClinicalTrials.gov Identifier: NCT02171078.

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