News | Breast Imaging | July 13, 2018

Breast Cancer Follow-up Imaging Varies Widely

Many low-risk patients receive high-cost procedures that are not recommended

 

Breast Cancer Follow-up Imaging Varies Widely

July 13, 2018 — Follow-up imaging for women with non-metastatic breast cancer varies widely across the country, according to a new study led by researchers at UC San Francisco. Some patients go without the annual mammograms that experts recommend, while others with the same cancer diagnosis receive full-body scans that expose them to significant amounts of radiation and are not recommended by experts.

Researchers said they could find no patterns in the data to explain the variation in care, but they suspected that it reflected differences in the common practices adopted by particular hospitals or physician groups. Full-body scans are expensive, costing between $2,000 and $8,000, and can be burdensome for patients who have high-deductible insurance policies that expose them to annual healthcare costs of $6,000 to $8,000 a year.

"With skyrocketing medical costs, patients are having to take greater and greater responsibility for out-of-pocket expenses," said UCSF's Benjamin Franc, M.D., MS, MBA, a professor in the Department of Radiology and Biomedical Imaging, the Center for Healthcare Value, and the Philip R. Lee Institute for Health Policy Studies. "These patients already have cancer, so you don't want to induce another cancer with radiation from unnecessary imaging."

The study, published in JNCCN: Journal of the National Comprehensive Cancer Network, examined data on 36,045 women aged 18 to 64 who had surgery for cancer in one breast between 2010 and 2012. To limit the group to patients with non-metastatic disease, the researchers excluded women who received chemotherapy in the first 18 months after their surgery. The data came from the Truven Health MarketScan Commercial Database and included information for all the metropolitan statistical areas (MSAs) in the country.

Guidelines from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend that women with non-metastatic breast cancer should receive annual physical exams and mammograms, but not full-body imaging with such technologies as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) or bone scans.

The researchers looked at an 18-month period, rather than a year, to allow time for patients to have completed any radiation therapy. They found that patients were more likely to receive recommended breast imaging within 18 months of surgery if they were younger or received radiation therapy. But the next most significant predictor was the patient's MSA. The biggest predictors of whether patients received PET imaging, which is not recommended, was the type of surgery, followed by MSA.

They found that 70.8 percent of women received at least one dedicated breast image, either a mammogram or a breast MRI, both of which are recommended for these patients. But 31.7 percent had at least one high-cost imaging procedure, and 12.5 percent had at least one PET, neither of which are recommended without a specific clinical symptom.

About half of the lowest-risk patients — those who received only surgery — received the recommended mammography within 18 months of their initial treatment. And between 64 and 70 percent of patients who had received a mastectomy and radiation, and were presumably higher risk, received some sort of breast imaging, either mammography or breast MRI. But depending on where they lived, between 18 and 46 percent of patients received high-cost tomographic imaging within 18 months of their surgeries.

"Age and therapy make sense as predictors of breast imaging, but it doesn't make sense that where you live makes a difference in whether you were likely to get a follow-up mammogram or high-cost imaging," Franc said. "What's actionable here is that we have these guidelines, but doctors aren't following them."

For more information: www.jnccn.org

Reference

Franc B.L., Copeland T.P., Thombley R., et al. “Geographic Variation in Postoperative Imaging for Low-Risk Breast Cancer.” Journal of the National Comprehensive Cancer Network, July 13, 2018. doi:10.6004/jnccn.2018.7024

Related Content

F-18 FES PET images of patients with ER+/PR+/HER2- invasive ductal carcinoma. Left panel: Progressive disease seen at the 8-week time-point in a patient on sequential therapy. Right panel: Stable disease through all 3 time-points, remaining on study therapy for 6.7 months until disease progression on combined vorinostat aromatase inhibitor therapy. Image created by Lanell M Peterson, Research Scientist, University of Washington Medical Oncology, Seattle WA.

F-18 FES PET images of patients with ER+/PR+/HER2- invasive ductal carcinoma. Left panel: Progressive disease seen at the 8-week time-point in a patient on sequential therapy. Right panel: Stable disease through all 3 time-points, remaining on study therapy for 6.7 months until disease progression on combined vorinostat aromatase inhibitor therapy. Image created by Lanell M Peterson, Research Scientist, University of Washington Medical Oncology, Seattle WA.

News | Molecular Imaging | February 22, 2021
February 22, 2021 — Molecular imaging
Examples of the imaging performance of XPCI-CT (b,e) compared to conventional specimen radiography (a,d) and benchmarked against histopathology (c,f). he top row focuses on the similarity between the XPCI-CT slice in (b) and the histological slice in (c). Arrow 1 indicates margin involvement, arrow 2 a variation in density in the internal structure of the tumour mass, arrow 3 tumour-induced inflammation. All this is confirmed by the histological slice in (c), and hardly visible in the conventional image in

Examples of the imaging performance of XPCI-CT (b,e) compared to conventional specimen radiography (a,d) and benchmarked against histopathology (c,f). he top row focuses on the similarity between the XPCI-CT slice in (b) and the histological slice in (c). Arrow 1 indicates margin involvement, arrow 2 a variation in density in the internal structure of the tumour mass, arrow 3 tumour-induced inflammation. All this is confirmed by the histological slice in (c), and hardly visible in the conventional image in (a). The bottom row focuses on the detection of small calcifications, a key feature in DCIS. These are undetectable in (d), detected in (e), enhanced in the maximum intensity projection (MIP) image at the bottom of (f), and confirmed by histopathology in the top part of (f). The scale bar [shown in (b) and (e)] is the same for all images apart from (f), which has its own scale. Red arrows in (e) and (f) indicate the microcalcifications. Image courtesy of Professor Alessandro Olivo

News | Breast Imaging | February 22, 2021
February 22, 2021 — A new X-ray imaging scanne
Axial FLAIR MR image shows T2 prolongation in bilateral middle cerebellar peduncles (arrows). Findings were associated with restricted diffusion and areas of T1 hypointense signal without enhancement or abnormal susceptibility. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

Axial FLAIR MR image shows T2 prolongation in bilateral middle cerebellar peduncles (arrows). Findings were associated with restricted diffusion and areas of T1 hypointense signal without enhancement or abnormal susceptibility. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

News | Coronavirus (COVID-19) | February 22, 2021
February 22, 2021 — According to an...
Example MR images from paediatric brain tumour patients. This first column shows T1-weighted images following the injection of gadolinium contrast agent. The second column shows T2-weighted images and the final column shows apparent diffusion coefficient maps calculated from diffusion-weighted images. (a–c) are taken from a patient with a Pilocytic Astrocytoma, (d–f) are from a patient with an Ependymoma and (g–i) were acquired from a patient with a Medulloblastoma.

Example MR images from paediatric brain tumour patients. This first column shows T1-weighted images following the injection of gadolinium contrast agent. The second column shows T2-weighted images and the final column shows apparent diffusion coefficient maps calculated from diffusion-weighted images. (ac) are taken from a patient with a Pilocytic Astrocytoma, (df) are from a patient with an Ependymoma and (gi) were acquired from a patient with a Medulloblastoma. Image courtesy of Nature Research Journal

News | Pediatric Imaging | February 17, 2021
February 17, 2021 — Diffusio...
A comparison of standard mammography imaging (left) in a woman with dense breasts and a breast MRI imaging study (right) showing a clearly defined cancer and is extremely hard to detect on the mammograms.

A comparison of standard mammography imaging (left) in a woman with dense breasts and a breast MRI imaging study (right) showing a clearly defined cancer and is extremely hard to detect on the mammograms. Images from Christiane Kuhl, M.D.

Feature | MRI Breast | February 17, 2021 | By Dave Fornell, Editor
Dense breast tissue can hide cancers i
T1 structural images for the two sequences, MPRAGE and MPRAGE+PMC. The top row shows the MPRAGE sequence, while the bottom row shows the images that were generated with the MPRAGE+PMC sequence. Columns represent two different participants, one with minimal head motion (left, Low-Mover) and another with a large quantity of motion (right, High-Mover). Pial and white matter (WM) surface reconstruction from Freesurfer are also shown.

T1 structural images for the two sequences, MPRAGE and MPRAGE+PMC. The top row shows the MPRAGE sequence, while the bottom row shows the images that were generated with the MPRAGE+PMC sequence. Columns represent two different participants, one with minimal head motion (left, Low-Mover) and another with a large quantity of motion (right, High-Mover). Pial and white matter (WM) surface reconstruction from Freesurfer are also shown.

News | Magnetic Resonance Imaging (MRI) | February 17, 2021
February 17, 2021 — A new paper,...
Immunotherapy-based precision medicine clinical trials being developed

Getty Images

News | Prostate Cancer | February 16, 2021
February 16, 2021 — Black men die more often of prostate cancer yet, paradoxically, have greater survival benefits fr
The research collaboration agreement covers a joint clinical retrospective study on liver fibrosis severity in Non-Alcoholic Steato-Hepatitis (NASH) patients
News | Artificial Intelligence | February 10, 2021
February 10, 2021 — Median Technologies announced the company has signed a research collaboration agreement with the
Screening strategy based on baseline breast density at age 40 may be effective and cost-effective for reducing breast cancer mortality

Getty Images

News | Breast Density | February 10, 2021
February 10, 2021 — A mammography screenin...
Unhealthy lifestyles, various diseases, stress, and aging can all contribute to an imbalance between the production of ROS and the body's ability to reduce and eliminate them. The resulting excessive levels of ROS cause "oxidative stress".

Unhealthy lifestyles, various diseases, stress, and aging can all contribute to an imbalance between the production of ROS and the body's ability to reduce and eliminate them. The resulting excessive levels of ROS cause "oxidative stress". Graphic courtesy of National Institutes for Quantum and Radiological Science and Technology

News | Magnetic Resonance Imaging (MRI) | February 10, 2021
February 10, 2021 — Oxygen is essential for human life, but within the body, certain biological environmental conditi