Mammographic surveillance in the follow up of early primary breast cancer in England: A cross-sectional survey

Abstract 

Purpose

The aim of this study was to determine current practice in the clinical setting at national and regional level of the use of mammographic surveillance in the follow up of patients surgically treated for early breast cancer.

Method

A cross-sectional survey method was employed. Self-administered questionnaires were sent to a random selection of symptomatic breast imaging units representing all the cancer networks in England nationally, and all symptomatic breast imaging units in one cancer network regionally. Questions were designed to determine frequency and duration of mammographic surveillance for patients aged<50 years and ≥50 years surgically treated by mastectomy or breast conserving surgery and the number of units with protocols based on the risk of local recurrence or development of a new primary breast cancer.

Results

The protocols demonstrated a striking diversity in both the frequency and duration of mammographic surveillance; however the variation was less marked regionally. The duration of mammography for patient's aged ≥70 years surgically treated by mastectomy, demonstrated the greatest diversity (range: 0–15 years). Four protocols had regimes tailored to risk.

Conclusion

The introduction of protocols based on risk of development of a local recurrence or new primary could prove cost effective by targeting mammographic surveillance to those who would benefit the most. The survey has demonstrated that a “post-code lottery” exists for both the frequency and duration of mammographic surveillance in this patient group indicating an urgent need for evidence based national guidance.

Keywords: Mammography, Local recurrence, New primary, Protocols, Survey