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    Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer

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    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 Institute
    Document Type
    Journal Article
    Publication Date
    2013-11-01
    Keywords
    Surveillance mammography
    Breast carcinoma
    Survivorship
    Clinical Epidemiology
    Epidemiology
    Geriatrics
    Health Services Research
    Neoplasms
    Oncology
    Women's Health
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1007/s10549-013-2720-x
    Abstract
    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-x
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/37256
    PubMed ID
    24113745
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s10549-013-2720-x
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