Breast cancer survivors turning their backs on recommended mammograms

A new study finds use of annual mammography among breast cancer survivors, who are at increased risk of a recurrence or a new malignancy in the other breast, dropped off after a few years. During the five year study period, only one in three women in this high-risk population had received regular annual mammograms.

Published in the June 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals the most significant factors predicting who got screened included being seen by a gynecologist or primary care physician and having been treated with breast conserving surgery.

There are more than 2.3 million women in the United States who have been treated for breast cancer. Women with a history of breast cancer face a three-fold increased risk of a malignancy in the other breast. Recommendations for follow-up of these women include annual mammography for early identification of subsequent cancers. In the general population, mammography has been demonstrated to be effective at reducing mortality. In breast cancer survivors, mammography has been shown to identify tumors at early stages, when treatment is more successful.

Existing studies show that mammography is underutilized by the general population and by Medicare beneficiaries who survived breast cancer. However, little is known about how often survivors with managed care health insurance are screened and how non-financial factors impact its use.

Chyke A. Doubeni, M.D., M.P.H. of the University of Massachusetts Medical School and colleagues reviewed mammography use in 797 women over the age of 55 who had been treated for breast cancer. Their objective was to identify patterns of mammography utilization in women when health insurance coverage is not a factor.

The researchers found that in the first year after treatment, 80 percent of women had received a screening mammogram. At the fifth year of follow-up, only 63 percent had received a mammogram that year, and only one in three women (33 percent) had received a mammogram each year over the five years.

Women who were being cared for by their gynecologist or primary care physician were the most likely to have mammograms in the fifth year. While the impact of physician specialty in mammography screening has been demonstrated in the general population, this is the first report of this association in breast cancer survivors. In addition, older women, particularly those with other medical conditions, and those with late-stage tumors were significantly less likely to have a mammogram.

The study indicates regular mammography for breast cancer survivors declines steadily within five years of treatment. "Efforts are needed to increase awareness among healthcare providers and breast cancer survivors on the value of follow-up mammography," say the authors.