216487 Breast Cancer Patient Surveillance after Initial Treatment

Tuesday, November 9, 2010 : 12:30 PM - 12:45 PM

Emad Allam, MD , Saint Louis University, St. Louis, MO
Udayan Kulkarni, BA , School of Medicine, St. Louis University, St. Louis, MO
Anand Patel, BA , School of Medicine, St. Louis University, St. Louis, MO
Julie Margenthaler, MD , Department of Surgery, Washington University, St. Louis, MO
Ling Chen, PhD , Division of Biostatistics, Washington University, St. Louis, MO
Katherine S. Virgo, PhD, MBA , Health Services Research Division, Surveillance & Health Policy Research Dept., American Cancer Society, Atlanta, GA
Frank E. Johnson, MD , Department of Surgery, Saint Louis University, St. Louis, MO
Introduction: There are 2.5 million breast cancer survivors in the US. Post-treatment follow-up is commonly done, but there is little data describing current practice. We aimed to determine what modalities are used, and how often they are recommended, in patient surveillance after curative-intent treatment for breast carcinoma.

Methods: We created a survey instrument with four idealized patient vignettes (TNM stages 0 - III) and questions about surveillance related to each vignette. We emailed surveys to the 3245 members of the American Society of Clinical Oncology who indicated that breast cancer was the focus of their clinical practice. The survey offered all 12 surveillance modalities that are mentioned in the relevant medical literature concerning follow-up strategies. We also requested that the survey recipients rate 11 potential motivating factors according to their importance.

Results: There were 1012 responses, of which 915 were evaluable. There was marked variation in follow-up intensity among these experts. For example, recommendations for mammograms ranged from 0 - 12 times per year in post-operative year one for the vignette featuring a Stage 0 patient. The strongest motivating factor was detection of a second primary breast cancer.

Conclusions: This is the first empirical data on this subject derived from a large sample of an international society of highly credentialed experts. The observed variation is prima facie evidence of overuse, underuse, and/or misuse of scarce medical resources. The medical, legal, and financial ramifications are large. Randomized controlled trials will be needed to determine the optimal follow-up strategy.

Learning Areas:
Administration, management, leadership
Chronic disease management and prevention
Clinical medicine applied in public health
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Learn how expert clinicians carry out surveillance in patients with breast cancer after initial treatment. Discuss the variation in practices among expert clinicians. List the guidelines for breast cancer follow-up. Develop a strategy for surveillance of breast cancer patients after curative-intent treatment.

Keywords: Breast Cancer, Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am the principal investigator on this project.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.