Department of Pharmacy, University of Washington, 1959 NE Pacific St, Box 357630, Seattle, WA, 98195, USA.
Breast Cancer Res Treat. 2014 Feb;143(3):541-50. doi: 10.1007/s10549-013-2816-3. Epub 2014 Jan 10.
Clinical practice guidelines recommend yearly surveillance mammography for breast cancer survivors, yet many women do not receive this service. The objective of this study was to evaluate factors related to long-term surveillance mammography adherence among breast cancer survivors. We conducted a retrospective cohort study among women ≥ 18 years, diagnosed with incident stage I or II breast cancer between 1990 and 2008. We used medical record and administrative health plan data to ascertain covariates and receipt of surveillance mammography for up to 10 years after completing breast cancer treatment. Surveillance included post-diagnosis screening exams among asymptomatic women. We used multivariable repeated measures generalized estimating equation regression models to estimate odds ratios and robust 95 % confidence intervals to examine factors related to the annual receipt of surveillance mammography. The analysis included 3,965 women followed for a median of six surveillance years; 79 % received surveillance mammograms in year 1 but decreased to 63 % in year 10. In multivariable analyses, women, who were < 40 years or 80+ years of age (compared to 50-59 years), current smokers, had greater comorbidity, were diagnosed more recently, had stage II cancer, or were treated with mastectomy or breast conserving surgery without radiation, were less likely than other women to receive surveillance mammography. Women with outpatient visits during the year to primary care providers, oncologists, or both were more likely to undergo surveillance. In this large cohort study of women diagnosed with early-stage invasive breast cancer, we found that important subgroups of women are at high risk for non-adherence to surveillance recommendations, even among younger breast cancer survivors. Efforts should be undertaken to actively engage breast cancer survivors in managing long-term surveillance care.
临床实践指南建议对乳腺癌幸存者进行年度监测乳房 X 光检查，但许多女性并未接受此项服务。本研究的目的是评估与乳腺癌幸存者长期监测乳房 X 光检查依从性相关的因素。我们对 1990 年至 2008 年间诊断出患有 I 期或 II 期乳腺癌的≥18 岁女性进行了回顾性队列研究。我们使用病历和行政健康计划数据确定协变量，并在完成乳腺癌治疗后最多 10 年内确定接受监测乳房 X 光检查的情况。监测包括对无症状女性进行诊断后的筛查检查。我们使用多变量重复测量广义估计方程回归模型来估计比值比和稳健的 95%置信区间，以检查与每年接受监测乳房 X 光检查相关的因素。该分析包括 3965 名中位随访时间为 6 年的女性；79%的女性在第 1 年接受了监测乳房 X 光检查，但在第 10 年下降到 63%。在多变量分析中，年龄<40 岁或>80 岁（与 50-59 岁相比）、当前吸烟者、合并症更多、最近诊断、II 期癌症、或接受乳房切除术或保乳手术而未接受放疗的女性与其他女性相比，接受监测乳房 X 光检查的可能性较小。在该年内有门诊就诊的女性，包括初级保健提供者、肿瘤学家或两者都有，更有可能接受监测。在这项针对早期浸润性乳腺癌女性的大型队列研究中，我们发现即使是年轻的乳腺癌幸存者，也有一些重要的亚组女性存在不遵守监测建议的高风险。应努力积极让乳腺癌幸存者参与管理长期监测护理。
