April 24, 2006 -- Annual mammograms are strongly recommended for women who have been treated for breast cancer, but surprising new research suggests that as many as two-thirds of survivors are not getting them.
Screening rates among survivors in the study were high early on. Four out of five had a mammogram in the first year after treatment. But mammography screening declined over time.
By year five, only a third of the women had had an annual mammogram every year since cancer treatment ended.
Approximately 2.3 million women in the U.S. have been treated for breast cancer.
"As time passes, women may think less and less about their breast cancer risk or they may be dealing with other illnesses," University of Massachusetts family medicine specialist Chyke Doubeni, MD, MPH, tells WebMD. "But it may be that former patients aren't really sure what they should be doing."
Why It Matters
It is clear that mammography screening is underutilized in the general population, but less is known about utilization rates among breast cancer survivors.
To address this issue, Doubeni and colleagues reviewed mammography screening records for 797 women who had been treated for breast cancer and whose screenings were covered by health insurance.
All of the women in the study were 55 or older at the beginning of the study, and their average age was just under 70.
In the first year following treatment, 80% of the women had a mammogram, but by the fifth year just 63% of the women were screened. Only 33% of the women were screened every year for five years.
Since all the women in the study had health care, cost was not believed to be a factor in declining utilization.
While age and the possible emergence of other health issues may have played a role, Doubeni says it also seems likely that many of these women fell through the cracks with regard to follow- up.
Women who regularly saw their primary care physician or gynecologist were more likely to get screened than women who did not.
Survivors 'Lost in Transition'
Doubeni says it is clear that more attention needs to be paid to follow-up care in the transition from cancer patient to cancer survivor. A report released by the nation's leading independent medical practices advisory group in November of last year makes the same point.
The Institute of Medicine report noted that too many survivors are "lost in transition" once treatment ends. It also called for every cancer survivor to have a comprehensive care summary and follow-up plan in writing that would include a specific schedule for future cancer screenings.
"Right now, many patients and their primary care physicians aren't really clear about what their follow-up needs are," Doubeni says.
Oncologist and breast cancer specialist Kathryn Edmiston, MD, says her relationship with patients does not end with treatment. She believes this is important because nonspecialists may not have the time to address the specific needs of breast cancer survivors.
"If you have 20 minutes with your primary care provider, the breast cancer you were treated for five or 10 years ago may not be what you discuss."
But the treatment of a host of conditions women face as they age, including menopause-related hot flashes and osteoporosis, may be different for breast cancer survivors.
Edmiston continues to see patients annually for the rest of their lives or until they decide to end the relationship. The practice is considered the standard of care at UMass Memorial Hospital, where she works.
"Women who have been treated for breast cancer remain at risk, and they should be followed by their oncologist for as long as they need to be," she says.