Breast Cancer Patient Surveillance after Initial Treatment

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.