Background. Patterns of surveillance among breast cancer survivors are not well characterized and lack evidence-based practice guidelines, particularly for imaging modalities other than mammography. We characterized breast imaging and related biopsy longitudinally among breast cancer survivors in relation to women’s characteristics. Methods. Using data from a state-wide (New Hampshire) breast cancer screening registry linked to Medicare claims, we examined use of mammography, ultrasound (US), magnetic resonance imaging (MRI), and biopsy among breast cancer survivors. We used generalized estimating equations (GEE) to model associations of breast surveillance with women’s characteristics. Results. The proportion of women with mammography was high over the follow-up period (81.5% at 78 months), but use of US or MRI was much lower (8.0%—first follow-up window, 4.7% by 78 months). Biopsy use was consistent throughout surveillance periods (7.4%–9.4%). Surveillance was lower among older women and for those with a higher stage of diagnosis. Primary therapy was significantly associated with greater likelihood of breast surveillance. Conclusions. Breast cancer surveillance patterns for mammography, US, MRI, and related biopsy seem to be associated with age, stage, and treatment, but need a larger evidence-base for clinical recommendations. 1. Introduction The National Cancer Institute (NCI) defines a cancer survivor as anyone who has been diagnosed with cancer, regardless of time since diagnosis, treatment status, or overall prognosis [1]. Because the overall mortality rates for breast cancer are relatively low while incidence is relatively high, there are estimated to be more than 2,000,000 women in the U.S. who are breast cancer survivors [2]. For these women, breast surveillance following completion of treatment is based on guidelines recommending annual surveillance mammography [3, 4], and on adoption of new technologies such as breast MRI [5]. Recommendations for annual mammographic surveillance do not stem from clinical trial evidence [6–9], but on evidence from observational studies and consensus panels. Consensus opinion holds that women with a personal history of breast cancer may benefit from early detection of subsequent breast cancers. Risk of new or recurrent breast cancer is increased among these women compared to women with no history of breast cancer. Survivors are at a 2 to 6 times greater risk of a new primary in the contralateral breast [10]. The overall risk of a recurrence or new primary breast cancer is estimated to be 5.4–6.6/1,000
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