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Lawson MB, Herschorn SD, Sprague BL, Buist DSM, Lee SJ, Newell MS, Lourenco AP, Lee JM. Imaging Surveillance Options for Individuals With a Personal History of Breast Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219:854-868. [PMID: 35544374 PMCID: PMC9691521 DOI: 10.2214/ajr.22.27635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Annual surveillance mammography is recommended for breast cancer survivors on the basis of observational studies and meta-analyses showing reduced breast cancer mortality and improved quality of life. However, breast cancer survivors are at higher risk of subsequent breast cancer and have a fourfold increased risk of interval breast cancers compared with individuals without a personal history of breast cancer. Supplemental surveillance modalities offer increased cancer detection compared with mammography alone, but utilization is variable, and benefits must be balanced with possible harms of false-positive findings. In this review, we describe the current state of mammographic surveillance, summarize evidence for supplemental surveillance in breast cancer survivors, and explore a risk-based approach to selecting surveillance imaging strategies. Further research identifying predictors associated with increased risk of interval second breast cancers and development of validated risk prediction tools may help physicians and patients weigh the benefits and harms of surveillance breast imaging and decide on a personalized approach to surveillance for improved breast cancer outcomes.
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Affiliation(s)
- Marissa B Lawson
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, University of Vermont Cancer Center, Burlington, VT
| | - Brian L Sprague
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Su-Ju Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Mary S Newell
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Ana P Lourenco
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
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Kjelle E, Andersen ER, Krokeide AM, Soril LJJ, van Bodegom-Vos L, Clement FM, Hofmann BM. Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Arne Magnus Krokeide
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Lesley J J Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Leti van Bodegom-Vos
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fiona M Clement
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics, The University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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Rodin D, Glicksman RM, Clark K, Kakani P, Cheung MC, Singh S, Rosenthal M, Sinaiko AD. Mammographic Surveillance in Older Women With Breast Cancer in Canada and the United States: Are We Choosing Wisely? Pract Radiat Oncol 2021; 11:e384-e394. [PMID: 33753302 DOI: 10.1016/j.prro.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Guidelines on mammographic surveillance after breast cancer treatment have been disseminated internationally and incorporated into Choosing Wisely recommendations to reduce low-value care. However, adherence within different countries before their publication is unknown. METHODS AND MATERIALS Low-value mammography, defined as "short-interval" (within 6 months of radiation) or "high-frequency" (>1 within 12 months of radiation), was compared in Medicare fee-for-service in the United States and Ontario, Canada. Women ≥65 years diagnosed with breast cancer who underwent breast-conserving therapy with a minimum of 24 months of follow-up were included (n = 19,715 United States; 6479 Ontario). Secondary outcomes were patient and physician characteristics associated with discordance. RESULTS Short-interval mammography was higher in the United States than in Ontario (55.9% vs 38.0%, P < .001), as was high-frequency (39.6% vs 7.9%, P < .001). In Ontario, younger age (42% ≥85 vs 58% <74 years, P < .001) and chemotherapy (69% vs 51%, P < .001) were associated with short-interval mammography; in the United States, age, earlier diagnosis year, stage, chemotherapy, rurality, and academic center treatment were associated with greater use. Chemotherapy was associated with high-frequency mammography in both countries (13% vs 7% in Ontario, P < .001; 69% vs 51% in United States, P = .02); younger age, earlier diagnosis year, stage, and nonacademic center treatment were associated in the United States. In both countries, radiation oncologists had the highest proportion of providers ordering low-value mammograms. CONCLUSIONS Despite significant evidence guiding surveillance mammography recommendations, there are high rates of short-interval mammography in both the United States and Ontario, and high rates of high-frequency mammography in the United States. Further international efforts, such as Choosing Wisely, are needed to reduce low-value mammography.
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Affiliation(s)
- Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Rachel M Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Clark
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Pragya Kakani
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Simron Singh
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anna D Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Hasan S, Abel S, Simpson-Camp L, Witten M, Aguilera L, Teng L, Philp FH, Julian TB, Trombetta M, Karlovits S, Cowher M. Short-Term Follow-Up Mammography in Breast Conservation Therapy Likely Leads to Unnecessary Downstream Workup: A Longitudinal Study. Int J Radiat Oncol Biol Phys 2018; 102:1489-1495. [DOI: 10.1016/j.ijrobp.2017.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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Swinnen J, Keupers M, Soens J, Lavens M, Postema S, Van Ongeval C. Breast imaging surveillance after curative treatment for primary non-metastasised breast cancer in non-high-risk women: a systematic review. Insights Imaging 2018; 9:961-970. [PMID: 30411278 PMCID: PMC6269345 DOI: 10.1007/s13244-018-0667-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The article summarises the available guidelines on breast imaging surveillance after curative treatment for locoregional breast cancer. METHODS A systematic review of practice guidelines published from 1 January 2007 to 1 January 2017 was performed according to PRISMA methodology. The search was conducted for the EMBASE, MEDLINE, Cochrane and Centre for Reviews and Dissemination databases. On 8 July 2018, all included guidelines were updated to the most recent version. RESULTS Twenty-one guidelines originating from 18 publishing bodies matched criteria. Publishing bodies consisted of seven governmental institutions, nine medical societies and two mixed collaborations. Publishing boards consisted of six radiological, four oncological, and 11 multidisciplinary teams. Annual bilateral mammography surveillance after breast-conserving therapy was recommended by 17/18 (94.4%) publishing bodies. Annual contralateral mammography surveillance after mastectomy was recommended by 13/18 (72.2%) publishing bodies. Routine use of digital breast tomosynthesis was recommended by 1/18 (5.6%) publishing bodies. Routine breast ultrasound surveillance was recommended by 2/18 (11.1%), deemed optional by 4/18 (22.2%) and not supported by 8/18 (44.4%) publishing bodies. Routine breast magnetic resonance imaging (MRI) surveillance was not recommended by 16/18 (88.9%) publishing bodies, although 6/18 (33.3%) specified subgroups for systematic MRI surveillance. CONCLUSIONS Annual mammography is currently the 'gold standard' for breast imaging surveillance. The role of digital breast tomosynthesis (DBT) remains to be further investigated. Most guidelines do not recommend routine breast ultrasound or MRI surveillance, unless indicated by additional risk factors.
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Affiliation(s)
- Jeroen Swinnen
- Department of Radiology, UZ Leuven, Herestraat 49, Leuven, Belgium
| | - Machteld Keupers
- Department of Radiology, UZ Leuven, Herestraat 49, Leuven, Belgium
| | - Julie Soens
- Department of Radiology, UZ Leuven, Herestraat 49, Leuven, Belgium
| | - Matthias Lavens
- Department of Radiology, UZ Leuven, Herestraat 49, Leuven, Belgium
| | - Sandra Postema
- Department of Radiology, UZ Leuven, Herestraat 49, Leuven, Belgium
| | - Chantal Van Ongeval
- Department of Radiology, UZ Leuven, Herestraat 49, Leuven, Belgium. .,Department of Imaging and Pathology, KU Leuven, Herestraat 49, Leuven, Belgium.
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Variability of Postsurgical Imaging Surveillance of Breast Cancer Patients: A Nationwide Survey Study. AJR Am J Roentgenol 2017; 210:222-227. [PMID: 29064749 DOI: 10.2214/ajr.17.17923] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Because of observed clinical variance and the discretion of referring physicians and radiologists in patient follow-up, the purpose of this study was to conduct a survey to explore whether broad discrepancy exists in imaging protocols used for postsurgical surveillance. SUBJECTS AND METHODS An online survey was created to assess radiologists' use of diagnostic versus screening mammography for women with a personal history of breast cancer and determine whether the choice of protocol was associated with practice characteristics (setting, region, and reader type). RESULTS Of 8170 surveys sent, 849 (10%) completed responses were returned. Seventy-nine percent of respondents recommended initial diagnostic mammography after lumpectomy (65% at 6 months, 14% at 12 months); 49% recommended diagnostic surveillance for up to 2 years before a return to screening mammography; and 33% continued diagnostic surveillance for 2-5 years before returning to screening. For imaging after mastectomy, 57% of respondents recommended diagnostic mammography of the unaffected breast. Among the 57%, however, 37% recommended diagnostic screening for only the first postmastectomy follow-up evaluation, and the other 20% permanently designated patients for diagnostic mammography after mastectomy. CONCLUSION The optimal surveillance mammography regimen must be better defined. This preliminary study showed variability in diagnostic versus screening surveillance mammography for women with a history of breast cancer. Future studies should evaluate why these variations occur and how to standardize recommendations to tailor personalized imaging.
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Wallace AS, Nelson JP, Wang Z, Dale PS, Biedermann GB. In support of the Choosing Wisely campaign: Perceived higher risk leads to unnecessary imaging in accelerated partial breast irradiation? Breast J 2017; 24:12-15. [DOI: 10.1111/tbj.12832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Audrey S. Wallace
- Department of Radiation Oncology; University of Alabama Birmingham Medical Center; Birmingham AL USA
- University of Missouri Columbia School of Medicine; Columbia MO USA
| | - Jay P. Nelson
- University of Missouri Columbia School of Medicine; Columbia MO USA
| | | | - Paul S. Dale
- Surgical Oncology; Navicent Health & Mercer College School of Medicine; Macon GA USA
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The role of early post-treatment mammography after breast conservation therapy. Am J Surg 2016; 211:850-3. [DOI: 10.1016/j.amjsurg.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/20/2016] [Accepted: 01/23/2016] [Indexed: 11/17/2022]
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McNaul D, Darke M, Garg M, Dale P. An evaluation of post-lumpectomy recurrence rates: is follow-up every 6 months for 2 years needed? J Surg Oncol 2012; 107:597-601. [PMID: 23280430 DOI: 10.1002/jso.23298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/08/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES There is currently debate about the optimal timing and frequency of mammography follow-up after breast-conserving therapy (BCT). The purpose of this study was to determine if 6-month intervals for the first 2 years following BCT offer benefit over annual screening. METHODS Three hundred ninety-nine patients who had lumpectomies between 1997 and 2009 and who were followed for at least 2 years with mammography were selected. The mammography yields for the first 2 years following BCT were compared to those of the general screening population. Also, patients were grouped as either compliant or noncompliant with the recommended 6-month intervals; Fischer's exact test was used to determine if there was a relationship between the grouping (compliant or noncompliant) and tumor recurrence. RESULTS Mammography yield was 0.94 and 2.87 per 1,000 for the first and second years, respectively, following surgery. Three hundred twenty-eight patients were categorized as compliant and 1 local recurrence was discovered in this group; 67 patients were labeled as noncompliant and 0 local recurrences were found in this group. CONCLUSIONS Mammography yield of cancer in the study population was not greater than the general population. There was no difference between the compliant and noncompliant groups regarding tumor recurrence.
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Affiliation(s)
- David McNaul
- Department of Radiology, University of Missouri, Columbia, MO, USA.
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Lewis JL, Tartter PI. The Value of Mammography Within 1 Year of Conservative Surgery for Breast Cancer. Ann Surg Oncol 2012; 19:3218-22. [DOI: 10.1245/s10434-012-2480-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Indexed: 11/18/2022]
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