4–20 Breast Cancer Yield for Screening Mammographic Examinations With Recommendation for Short-Interval Follow-up

Purpose The number of breast cancer survivors at risk of developing contralateral breast cancer (CBC) is increasing. However, ambiguity remains regarding risk factors and prognosis for women with CBC. Patients and Methods In a cohort of 42,670 women with breast cancer in the Uppsala/Örebro and Stockholm regions in Sweden in 1992 to 2008, we assessed risk factors for and prognosis of metachronous CBC by using survival analysis. Breast cancer–specific survival for women with CBC was evaluated and compared with results for women with unilateral breast cancer (UBC) by using time-dependent Cox-regression modeling. Results An increased risk for CBC was observed among women who had primary breast cancer with ≥ 10 involved lymph nodes compared with node-negative women (adjusted hazard ratio [HR], 1.8; 95% CI, 1.2 to 2.7). The prognosis was poorer in women with CBC than with UBC. The hazard of dying from breast cancer was especially high for women with a short interval time to CBC (adjusted HR, 2.3; 95% CI, 1.8 to 2.8 for CBC diagnosed ≤ 5 years v UBC) and gradually decreased with longer follow-up time but remained higher than the hazard originating from the primary tumor for ≥ 10 years. Conclusion Women with advanced-stage primary breast cancer had an increased risk of developing CBC. CBC is associated with an increased risk of dying from breast cancer throughout a long period of follow-up after the primary tumor. Our findings suggest that the event of CBC marks a new clinical situation in terms of investigations for metastases, treatment considerations, and follow-up strategy.

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Estrogen Alone in Postmenopausal Women and Breast Cancer Detection by Means of Mammography and Breast Biopsy

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.8799 ◽

2010 ◽

Vol 28 (16) ◽

pp. 2690-2697 ◽

Cited By ~ 23

Author(s):

Rowan T. Chlebowski ◽

Garnet Anderson ◽

JoAnn E. Manson ◽

Mary Pettinger ◽

Shagufta Yasmeen ◽

...

Keyword(s):

Breast Cancer ◽

Postmenopausal Women ◽

Cancer Detection ◽

Breast Biopsy ◽

Short Interval ◽

Screening Mammography ◽

Breast Cancer Detection ◽

Early Years ◽

Breast Cancers

Purpose As the influence of estrogen alone on breast cancer detection is not established, we examined this issue in the Women's Health Initiative trial, which randomly assigned 10,739 postmenopausal women with prior hysterectomy to conjugated equine estrogen (CEE; 0.625 mg/d) or placebo. Methods Screening mammography and breast exams were performed at baseline and annually. Breast biopsies were based on clinical findings. Effects of CEE alone on breast cancer detection were determined by using receiver operating characteristic (ROC) analyses of mammogram performance. Results After a 7.1-year mean follow-up, fewer invasive breast cancers were diagnosed in the CEE than in the placebo group, but the difference was not statistically significant. Use of CEE alone increased mammograms with short-interval follow-up recommendations (cumulative, 39.2% v 29.6.3%; P < .001) but not abnormal mammograms (ie, those suggestive of or highly suggestive of malignancy; cumulative, 7.3% v 7.0%; P = .41). Breast biopsies were more frequent in the CEE group (cumulative, 12.5% v 10.7%; P = .004) and less commonly diagnosed as cancer (8.9% v 15.8%, respectively, with positive biopsies; P = .04). Mammographic breast cancer detection in the CEE group was significantly compromised only in the early years of use. Conclusion CEE alone use for 5 years results in approximately one in 11 and one in 50 women having otherwise avoidable mammograms with short-interval follow-up recommendations or breast biopsies, respectively. Although the breast biopsies on CEE were less commonly diagnosed as cancer, breast cancer detection was not substantially compromised. These findings differ from estrogen-plus-progestin use, for which significantly increased abnormal mammograms and a compromise in breast cancer detection are seen.

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Breast Cancer Detection with Short-Interval Follow-up Compared with Return to Annual Screening in Patients with Benign Stereotactic or US-guided Breast Biopsy Results

Radiology ◽

10.1148/radiol.14140036 ◽

2015 ◽

Vol 275 (1) ◽

pp. 54-60 ◽

Cited By ~ 9

Author(s):

Jason M. Johnson ◽

Alisa K. Johnson ◽

Ellen S. O’Meara ◽

Diana L. Miglioretti ◽

Berta M. Geller ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Detection ◽

Breast Biopsy ◽

Short Interval ◽

Breast Cancer Detection ◽

Annual Screening

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Followup mammography after breast conservation therapy: Is 3D Tomosynthesis(3DT) worth it?

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6628 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6628-6628

Author(s):

Shaakir Hasan ◽

Steven Gresswell ◽

Brittany Colosimo ◽

Kevin Weinberger ◽

Sidney Anderson ◽

...

Keyword(s):

Breast Cancer ◽

Short Interval ◽

Multivariable Analysis ◽

Breast Conservation ◽

Cost Effective ◽

Breast Conservation Therapy ◽

Post Treatment ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation

6628 Background: Screening three-dimensional tomosynthesis mammography (3DT) is more cost-effective than two-dimensional mammography (2DM) for detecting breast cancer, however cost-effectiveness as a follow-up for treated breast cancer is unknown. We retrospectively analyzed the downstream workup and costs associated with 3DT compared to 2DM when employed as initial follow-up imaging in breast conservation therapy (BCT). Methods: Between the years 2015-2017, 450 consecutive BCT patients ages 32 – 89 with a follow-up 3DT (n = 162) or 2DM (n = 288) were reviewed in this IRB-approved study. The primary endpoint was further workup after follow-up mammogram and associated healthcare costs at 1 year. Downstream workup was secondarily tested for correlation with clinical and treatment-related variables. A single 3DT cost an estimated $149 compared to $111 for a 2DM, based on Centers for Medicare claims data Oncology Care Model. Results: Patient clinical characteristics were : 6% DCIS, 10% T1a, 29% T1b, 35% T1c, 19% T2, 88% N0, 9% N1, 3% N2, 76% ER+/PR+/HerNeu2-, 12% TNBC, and 14% Her2Neu+. Whole breast radiation was given with conventional (59%) and hypo (39%) fractionation (81% with a boost), and 10% received accelerated partial breast irradiation. First post-treatment mammogram was received within 3 months (20%), 3-6 months (32%), and after 6 months (48%) following RT. There were no differences in breast density, patient age, T/N stage, receptor status, type of RT, or mammogram timing between those in the 2DM and 3DT groups. The following downstream workup ensued for 3DT compared to 2D imaging: 18% vs 29% short-interval (6-month) mammogram (OR = 1.83, P = 0.01), 6% vs 11% breast MRI (OR = 1.90, P = 0.08), 4% ultrasound for each, and 3% biopsy for each (1 positive in the 2D group). Including downstream workup, the estimated cost per patient in the 3DT group = $249.00 compared to $253.64 in the 2D group. With multivariable analysis the independent predictors for reduced downstream workup was the use of 3DT and follow-up mammogram at least 6 months after radiation (P < 0.05). Conclusions: Excess workup was reduced with 3DT compared to 2DM in the post-treatment setting. A single 3DT costs approximately 34% more than 2DM, however in this study the associated reduction in downstream workup with 3DT actually made it more cost-effective.

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