Originally published as JCO Early Release 10.1200/JCO.2008.18.5876 on May 11 2009

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Nekhlyudov, L. Articles by Fletcher, S. W. PubMed PubMed Citation Articles by Nekhlyudov, L. Articles by Fletcher, S. W. Social Bookmarking                            What's this?

Adherence to Long-Term Surveillance Mammography Among Women With Ductal Carcinoma In Situ Treated With Breast-Conserving Surgery

From the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care; Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Division of Research, Kaiser Permanente Northern California, Oakland; Kaiser Permanente Southern California, Pasadena, CA; and the Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX.

Corresponding author: Larissa Nekhlyudov, MD, MPH, Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215; e-mail: Larissa_nekhlyudov{at}harvardpilgrim.org.

Purpose Breast-conserving surgery (BCS) is an effective treatment for ductal carcinoma in situ (DCIS) but women who undergo BCS remain at risk for recurrences. Whether mammographic surveillance after BCS occurs and by whom is not known.

Methods We reviewed medical records of women diagnosed with DCIS between 1990 and 2001 and treated with BCS. Using descriptive statistics, generalized estimating, and logistic regression modeling, we examined the rates and predictors of surveillance mammography over a 10-year period after BCS.

Results The cohort included 3,037 women observed for a median of 4.8 years (range, 0.5 to 15.7). Of the 2,676 women observed for at least 1 year after BCS, most (79%) had at least one surveillance mammogram during the first year of follow-up; 69% in year 5 and 61% in year 10. Among those observed for 5 years, surveillance mammograms were more likely among women age 60 to 69 years (odds ratio [OR], 1.72; 95% CI, 1.26 to 2.34), users of menopausal hormone therapy at diagnosis (OR, 1.26; 95% CI, 1.01 to 1.57) as well as those treated with adjuvant radiation (OR, 1.28; 95% CI, 1.08 to 1.53) and adjuvant radiation with tamoxifen (OR, 1.61; 95% CI, 1.13 to 2.30). Surveillance mammograms were less likely among obese women (OR, 0.70; 95% CI, 0.56 to 0.86). The findings were similar among women observed for 10 years. Only 34% and 15% of women observed for 5 and 10 years, respectively, had a surveillance mammogram during each year of follow-up.

Conclusion Surveillance mammography after BCS among insured women with DCIS often did not occur yearly and declined over time after treatment. Patients and providers must remain vigilant about surveillance after BCS.

Supported by Grant No. U19CA79689 to the Cancer Research Network from the National Cancer Institute, and by Public Health Service Grant No. R01CA81302 (L.A.H., N.S.A., C.P.Q.).

Presented in part at the Annual Meeting of the Society of General Internal Medicine, Los Angeles, CA, April 26-29, 2006, and at the HMO Research Network Meeting, Cambridge, MA, May 1-3, 2006.

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

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?