Medical surveillance after breast cancer diagnosis.
OBJECTIVE
To characterize the tests ordered for surveillance of breast cancer recurrence in the 4 years after breast cancer diagnosis by surgeons, medical oncologists, and radiation oncologists.


METHODS
303 stage I or II breast cancer patients age 55-years or older and diagnosed at 1 of 5 Boston hospitals. Patient interviews and medical record abstracts provided the data to characterize patient demographics, the breast cancer stage and its primary therapy, and the surveillance procedures ordered.


RESULTS
279 of the 303 women had some surveillance testing. Among those who received some surveillance, a mean of 22.0 tests were ordered, most by their medical oncologists (mean = 14.4), followed by their surgeons (mean = 9.7) and their radiation oncologists (mean = 5.7). The most common test was a mammogram (mean = 3.9). Women ages 75 to 90 years old were at higher risk for failure to complete four consecutive years of surveillance and for receipt of less than guideline surveillance. Younger women, women treated at a breast cancer center with a unified patient chart, and women who worked full or part time were at lower risk for failure to complete 4 years of surveillance.


CONCLUSIONS
Most women in this cohort received some surveillance after completing primary therapy for breast cancer. Although no woman's surveillance corresponded exactly to existing guidelines, the oldest women were least likely to receive guideline surveillance. Surveillance after breast cancer therefore joins the list of aspects of breast cancer care-breast cancer screening, diagnosis, prognostic evaluation, and primary therapy-for which older women receive less than definitive care.
Lash
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School of Public Health, Boston University Medical Center, Massachusetts 02118, USA. tlash@bu.edu
Silliman
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D000367:Age Factors; D000368:Aged; D001900:Boston; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000592:standards*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D009367:Neoplasm Staging / Q000145:classification; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018787:Radiation Oncology / Q000592:standards; D055502:Secondary Prevention; D016387:Women's Health