Onega Tracy, Weiss Julie, Diflorio Roberta, Mackenzie Todd, Goodrich Martha, Poplack Steven
Department of Community and Family Medicine, Geisel School of Medicine at Darmouth, Lebanon, NH 03756, USA ; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Darmouth, Lebanon, NH, USA ; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Int J Breast Cancer. 2012;2012:347646. doi: 10.1155/2012/347646. Epub 2012 Oct 14.
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.
背景。乳腺癌幸存者的监测模式尚未得到充分描述，且缺乏循证实践指南，尤其是对于乳腺钼靶检查以外的成像方式。我们根据女性特征纵向描述了乳腺癌幸存者的乳腺成像及相关活检情况。方法。利用与医疗保险理赔记录相链接的全州（新罕布什尔州）乳腺癌筛查登记处的数据，我们研究了乳腺癌幸存者中乳腺钼靶检查、超声（US）、磁共振成像（MRI）及活检的使用情况。我们使用广义估计方程（GEE）对乳腺监测与女性特征之间的关联进行建模。结果。在随访期间，进行乳腺钼靶检查的女性比例较高（78个月时为81.5%），但超声或MRI的使用比例要低得多（第一个随访窗口时为8.0%，到78个月时为4.7%）。活检的使用在整个监测期间保持一致（7.4% - 9.4%）。老年女性及诊断分期较高的女性的监测率较低。初始治疗与更高的乳腺监测可能性显著相关。结论。乳腺癌幸存者中乳腺钼靶检查、超声、MRI及相关活检的监测模式似乎与年龄、分期及治疗有关，但需要更多证据以形成临床推荐。
