Online Program

Breast cancer patient surveillance following curative-intent treatment: Variation among US census regions

Sunday, November 3, 2013

Robert J. Avino, BA, Dept. of Surgery, Saint Louis University, St. Louis, MO
Emad S. Allam, MD, Deptartment of Radiology, Saint Louis University, St. Louis, MO
Ling Chen, PhD, Division of Biostatistics, Washington University, St. Louis, MO
Katherine S. Virgo, PhD, MBA, Health Services Research, American Cancer Society, Atlanta, GA
Julie A. Margenthaler, MD, Department of Surgery, Washington University, St. Louis, MO
Frank E. Johnson, MD, Deptartment of Surgery, Saint Louis University, Saint Louis, MO
Background: There are about 3 million breast cancer survivors in the US, with about 230,000 new cases of breast cancer diagnosed annually. Most patients receive curative-intent treatment. Post-treatment surveillance is commonly done and we have previously documented dramatic variation in surveillance intensity among ASCO experts. The only surveillance modalities endorsed by ASCO for asymptomatic patients are office visit and mammogram. ASCO guidelines specify that all other modalities are not recommended. We sought to determine the effect of the physician's practice location on the intensity of surveillance by comparing US Census Regions. Methods: The 3245 ASCO members who had indicated that breast cancer was a major clinical focus of their practice were surveyed regarding their surveillance practices. Members were asked to consider 4 idealized clinical vignettes and indicate their surveillance plan for each. A menu of 12 testing modalities was offered. Repeated-measures ANOVA was employed to compare practice patterns by US Census Region. Statistical significance was set at p<0.05. Results: There were 1012 responses; 915 were evaluable. The modalities most frequently recommended were office visit, CBC, LFTs, and mammogram. We analyzed the 4 US Census Regions plus a category called Foreign. Significant variation (p<0.05) in recommended frequency of use was present for all frequently recommended surveillance modalities. For example, in year 1 mammogram was recommended 1.5 ± 0.8 (mean ±SD) times in the Midwest Census Region and 1.9 ± 1.8 times in the South Census Region. Every modality discouraged by ASCO was recommended by some respondents. Conclusions: Evidence-based clinical guidelines have proven effective in providing high quality care and decreasing variation in practice. ASCO members often recommend surveillance modalities that are not recommended by the evidence-based ASCO clinical guidelines, suggesting overuse. Statistically significant variation among the US Census Regions was present. However, this variation was clinically quite small. Variation among US Census Regions cannot explain the known marked variation in clinical practice we have previously documented.

Learning Areas:

Administration, management, leadership
Clinical medicine applied in public health
Provision of health care to the public

Learning Objectives:
Compare the surveillance practices after curative-intent breast cancer treatment by US Census Regions. Describe the current dramatic variation in surveillance intensity for breast cancer patients after initial treatment.

Keyword(s): Breast Cancer, Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a surgical oncologist dealing with breast cancer patients.
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.