Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer
Authors
Buist, Diana S. M.Bosco, Jaclyn L. F.
Silliman, Rebecca A.
Gold, Heather Taffet
Field, Terry S.
Yood, Marianne Ulcickas
Quinn, Virginia P.
Prout, Marianne N.
Lash, Timothy L.
Breast Cancer Outcomes in Older Women (BOW) Investigators
UMass Chan Affiliations
Meyers Primary Care InstituteDocument Type
Journal ArticlePublication Date
2013-11-01Keywords
Surveillance mammographyBreast carcinoma
Survivorship
Clinical Epidemiology
Epidemiology
Geriatrics
Health Services Research
Neoplasms
Oncology
Women's Health
Metadata
Show full item recordAbstract
Annual surveillance mammograms in older long-term breast cancer survivors are recommended, but this recommendation is based on little evidence and with no guidelines on when to stop. Surveillance mammograms should decrease breast cancer mortality by detecting second breast cancer events at an earlier stage. We examined the association between surveillance mammography beyond 5 years after diagnosis on breast cancer-specific mortality in a cohort of women aged >/= 65 years diagnosed 1990-1994 with early stage breast cancer. Our cohort included women who survived disease free for >/= 5 years (N = 1,235) and were followed from year 6 through death, disenrollment, or 15 years after diagnosis. Asymptomatic surveillance mammograms were ascertained through medical record review. We used Cox proportional hazards regression stratified by follow-up year to calculate the association between time-varying surveillance mammography and breast cancer-specific and other-than-breast mortality adjusting for site, stage, primary surgery type, age and time-varying Charlson Comorbidity Index. The majority (85 %) of the 1,235 5-year breast cancer survivors received >/= 1 surveillance mammogram in years 5-9 (yearly proportions ranged from 48 to 58 %); 82 % of women received >/= 1 surveillance mammogram in years 10-14. A total of 120 women died of breast cancer and 393 women died from other causes (average follow-up 7.3 years). Multivariable models and lasagna plots suggested a modest reduction in breast cancer-specific mortality with surveillance mammogram receipt in the preceding year (IRR 0.82, 95 % CI 0.56-1.19, p = 0.29); the association with other-cause mortality was 0.95 (95 % CI 0.78-1.17, p = 0.64). Among older breast cancer survivors, surveillance mammography may reduce breast cancer-specific mortality even after 5 years of disease-free survival. Continuing surveillance mammography in older breast cancer survivors likely requires physician-patient discussions similar to those recommended for screening, taking into account comorbid conditions and life-expectancy.Source
Buist DS, Bosco JL, Silliman RA, Gold HT, Field T, Yood MU, Quinn VP, Prout M, Lash TL; Breast Cancer Outcomes in Older Women (BOW) Investigators. Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer. Breast Cancer Res Treat. 2013 Nov;142(1):153-63. doi: 10.1007/s10549-013-2720-x. Link to article on publisher's site
DOI
10.1007/s10549-013-2720-xPermanent Link to this Item
http://hdl.handle.net/20.500.14038/37256PubMed ID
24113745Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1007/s10549-013-2720-x