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By Sarah L. Zielinski

Where's the Follow-Up?

Many breast cancer survivors are not getting recommended mammograms

By Sarah L. Zielinski


While regular physician visits and clinical exams are vital to post-treatment care, mammography is the only recommended annual surveillance test for recurrence or new breast cancers for the 2.3 million women in the U.S. who’ve undergone treatment for breast cancer. But many survivors are forgoing their annual screening mammograms, according to two studies published this year.

In the first study, published in the Jan. 1 issue of the Journal of Clinical Oncology, Nancy Keating, a general internist at Brigham and Women’s Hospital and Harvard Medical School in Boston, and her colleagues examined Medicare data from more than 44,500 breast cancer survivors ages 65 and older. Only 57 percent of the 23,016 women who were alive three years after diagnosis got mammograms annually during those three years.

In the second study, which appeared in the June 1 issue of Cancer, Chyke Doubeni, a family physician at the University of Massachusetts Medical School in Worcester, and his colleagues examined the insurance data of nearly 800 breast cancer survivors ages 55 and older. Of the 262 women who had five years of follow-up care after treatment, only a third had mammograms annually during those years.

Both studies found that older women, and particularly those with other health problems, were less likely to get mammograms. Women who saw a primary care physician or a cancer specialist were more likely to receive mammograms, but Doubeni suggests that even women who see a primary care physician and a cancer specialist might fall through the cracks if each doctor assumes the other will recommend a mammogram.

The reports “serve to remind clinicians that they need to remind patients to do these follow-up exams and talk about why they’re important,” says Monica Morrow, a surgical oncologist at Fox Chase Cancer Center in Philadelphia. She says patients should check with their health care providers to ensure they are receiving all the follow-up care they need.

The studies do not establish why patients did not get mammograms: “That’s what we need to know,” says Morrow. Answering that question may help solve the problem. It’s an issue that Doubeni plans to focus on next.

Jean Sachs, the executive director of the nonprofit support organization Living Beyond Breast Cancer, says these studies suggest the need for better communication in post-cancer care. “There needs to be a comprehensive follow-up plan, and breast cancer specialists need to be in better communication with [other caregivers],” she says.