A new evaluation of international breast cancer guidelines has highlighted potential to improve the monitoring of breast cancer survivors, both from a patient and health system perspective. The findings were recently published in Value in Health by researchers from the University of Adelaide (Australia).
Currently, international guidelines make recommendations for yearly follow-up mammograms for all women who have been treated for early breast cancer, regardless of the likelihood of cancer recurrence. Despite this, there is presently no strong evidence to support the scheduling of annual follow-up mammograms compared with other possible mammography schedules.
“Due to early diagnosis and improved treatment, the number of breast cancer survivors is increasing. All of these women will need follow-up mammography to detect recurrent or new disease,” explained the study co-author, Jon Karnon (University of Adelaide). “But while the diagnosis and treatment have significantly improved the outlook for many cancer patients, approaches to cancer surveillance haven’t changed,” he continued.
The team utilized health service data and simulation modeling to enable them to predict the long-term costs and health outcomes of a variety of possible mammography schedules. These schedules were based on the patients’ ages as well as the features of their primary breast cancer.
The analysis indicated that less frequent mammograms may be more cost-effective for postmenopausal women with moderate prognosis for early breast cancer, particularly those over 70 years of age. The results demonstrated that for younger postmenopausal women at moderate risk of breast cancer recurrence, annual follow-up mammograms for 5 years, followed by screenings every 2 years represents a cost-effective solution. For older women, a 2-year mammography schedule from the outset was recommended.
“It’s clear to us that the current ‘one-size-fits-all’ international guideline of annual follow-up mammography may not be necessary for all women with early breast cancer,” commented co-author Taryn Bessen (University of Adelaide).
“This work highlights the potential benefit of tailoring follow-up to the risk of recurrence, and the use of modeling methods to help guide clinical practice in an evidence-based and pragmatic manner,” concluded Bessen.