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Surveillance Testing Among Survivors of Early-Stage Breast Cancer

Nancy L. Keating, Mary Beth Landrum, Edward Guadagnoli, Eric P. Winer, John Z. Ayanian

From the Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital; Department of Health Care Policy, Harvard Medical School; and the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA

Address reprint requests to Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115; e-mail: keating{at}hcp.med.harvard.edu

Purpose: Guidelines recommend against routine surveillance testing for women who have had breast cancer. We described follow-up care for breast cancer survivors, examined how surveillance testing varies by the types of physicians seen, and assessed changes in testing rates over time.

Methods: Using Surveillance, Epidemiology, and End Results–Medicare data, we studied a population-based cohort of 44,511 women age 65 years diagnosed with stage I/II breast cancer during 1992 to 1999 and observed through 2001. We measured bone scans, tumor antigen tests, chest x-rays, and other chest/abdominal imaging during 3 consecutive surveillance years. We described physicians seen in follow-up and used repeated-measures logistic regression to assess the relationship with testing and to assess testing trends over time.

Results: Nearly half of breast cancer survivors saw a medical oncologist in surveillance year 1, but only 27% saw a medical oncologist annually for 3 years. In adjusted analyses, women seeing medical oncologists had more bone scans, tumor antigen testing, chest x-rays, and chest/abdominal imaging than other women (all P < .001). Nevertheless, rates of testing decreased over time (all P < .001). Rates of tumor antigen testing and chest x-rays decreased faster and chest/abdominal imaging increased slower among women seeing medical oncologists than among other women (all P < .05).

Conclusion: Nonrecommended testing for early-stage breast cancer patients has decreased over time. Although most breast cancer survivors did not see oncologists annually, those who did had substantially higher rates of testing than others; whether such testing in this low-risk population was due to more symptoms or excessive surveillance is an important question for additional study.

Supported by a Clinical Scientist Development Award from the Doris Duke Charitable Foundation (N.L.K.).

The funding organization had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.