Comparison of post-treatment breast cancer surveillance strategies among oncology specialties

Introduction: American Society of Clinical Oncology (ASCO) guidelines currently recommend only clinic visits and mammograms for post-treatment surveillance of breast cancer. We compared the intensity of breast cancer patient surveillance after initial breast cancer therapy and quantified differences in post-treatment surveillance practices among radiation oncologists (RO), medical oncologists (MO) and surgeons (SO). Methods: We designed a survey instrument with 4 patient vignettes. We emailed them to the 3245 ASCO members who identified themselves as having breast cancer as a major focus of their practice. Responses were grouped for all 4 vignettes and median, range, mean and standard deviation of frequency of use for 12 surveillance modalities were determined. Results: There were 1012 total responses; 846 were evaluable. 70% were from MO, 5% were from RO, 10% were from SO and 15% were unspecified. Significant variation across specialties was evident and all 10 modalities not recommended by ASCO guidelines were utilized by some clinicians. In year 1, MO requested 1.6 ± 1.6 (mean ± SD) mammograms; RO requested 1.7 ± 0.9; SO requested 1.4 ± 0.6 (p> 0.4). In year 1, MO recommended 3.5 ± 1.6 (mean ± SD) office visits, RO recommended 3.1 ± 1.4 and SO recommended 3.0 ± 1.7. These differences were statistically significant (p< 0.001, ANOVA) but clinically small. Conclusions: Improved medical education is needed to inform clinicians and trainees about evidence from randomized controlled trials regarding optimal post-treatment surveillance, as there is significant variation among specialties in their use of surveillance modalities.