Surveillance testing among survivors of early-stage breast cancer.
OBJECTIVE
Guidelines recommend against routine surveillance testing for women who have had breast cancer. We described follow-up care for breast cancer survivors, examined how surveillance testing varies by the types of physicians seen, and assessed changes in testing rates over time.


METHODS
Using Surveillance, Epidemiology, and End Results-Medicare data, we studied a population-based cohort of 44,511 women age > or = 65 years diagnosed with stage I/II breast cancer during 1992 to 1999 and observed through 2001. We measured bone scans, tumor antigen tests, chest x-rays, and other chest/abdominal imaging during 3 consecutive surveillance years. We described physicians seen in follow-up and used repeated-measures logistic regression to assess the relationship with testing and to assess testing trends over time.


RESULTS
Nearly half of breast cancer survivors saw a medical oncologist in surveillance year 1, but only 27% saw a medical oncologist annually for 3 years. In adjusted analyses, women seeing medical oncologists had more bone scans, tumor antigen testing, chest x-rays, and chest/abdominal imaging than other women (all P < .001). Nevertheless, rates of testing decreased over time (all P < .001). Rates of tumor antigen testing and chest x-rays decreased faster and chest/abdominal imaging increased slower among women seeing medical oncologists than among other women (all P < .05).


CONCLUSIONS
Non-recommended testing for early-stage breast cancer patients has decreased over time. Although most breast cancer survivors did not see oncologists annually, those who did had substantially higher rates of testing than others; whether such testing in this low-risk population was due to more symptoms or excessive surveillance is an important question for additional study.
Keating
Nancy L
NL
Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. keating@hcp.med.harvard.edu
Landrum
Mary Beth
MB
Guadagnoli
Edward
E
Winer
Eric P
EP
Ayanian
John Z
JZ
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care / Q000706:statistics & numerical data; D008495:Medical Oncology / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011320:Primary Health Care / Q000706:statistics & numerical data; D018426:SEER Program; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data* / Q000639:trends