New research published in Health Technology Assessment has found that surveillance using mammography increases the survival chances of breast cancer patients.
Around 45,000 women are diagnosed with breast cancer in the UK every year. Outcomes are improving and many women do not suffer from a recurrence. To ensure that any recurrences are detected early, women are given regular follow up appointments for up to three years.
Research led by Professor Fiona Gilbert of the University of Aberdeen, aimed to determine the most effective and cost-effective method of surveillance following breast cancer treatment, in terms of frequency, effectiveness, safety and efficiency.
"There is currently debate surrounding the follow-up process in terms of frequency and detection method," commented Professor Gilbert. "Early detection of primary and secondary cancers increases the likelihood of survival, but the frequency that mammographic surveillance should be used is not clear."
The researchers conducted two systematic reviews and surveyed breast surgeons and radiologists to determine current practice and estimate cost-effectiveness. They also modelled patient data from a number of sources, including the West Midlands Cancer Intelligence Unit Breast Cancer Registry.
The results of the survey show that whilst there are similarities, the use of mammographic surveillance differs in terms of start, frequency, duration and discharge. Data from systematic reviews suggests that mammographic surveillance increases the chances of survival compared to follow-ups that do not include this and MRIs are the most accurate way of detecting new growths. However, the efficacies of combinations of other modes of surveillance, such as clinical examination, are unclear. The patient data suggests that women who have a smaller secondary tumour (less than 10mm in diameter) have a higher chance of survival.
Mammographic surveillance was found to be cost-effective when provided on a 12 month basis. This was best used for women who were more likely to develop a secondary or primary tumour, but more cost-effective when used every three years for women who were unlikely to develop another growth.
"The results of our research demonstrate that mammographic surveillance is an effective and cost-effective way of detecting new growths," said Professor Gilbert. "Our research has the potential to influence the way in which follow up appointments are organised in the future."
As a result of questions raised by this research, the HTA programme has issued a call for proposals on surveillance regimes following early breast cancer.
The research was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme.
- Robertson, C. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews, registry database analyses and economic evaluation. Health Technol Assess, 2011; Vol 15:34 DOI: 10.3310/hta15340
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