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Special Communication
January 28, 2021

Individualizing Surveillance Mammography for Older Patients After Treatment for Early-Stage Breast Cancer: Multidisciplinary Expert Panel and International Society of Geriatric Oncology Consensus Statement

Author Affiliations
  • 1Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 2Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
  • 4Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco
  • 5Division of Geriatrics, Veterans Affairs Health Care System, San Francisco, California
  • 6Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
  • 7Department of General Medical Oncology and Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven, Belgium
  • 8Division of Medical Oncology, Washington University School of Medicine, St Louis, Missouri
  • 9Memorial Sloan Kettering Cancer Center, Commack, New York
  • 10James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
  • 11Department of Medical Oncology, Institut Curie, Saint-Cloud, France
  • 12Department of Medicine, Rush University Medical College and Cook County Health, Chicago, Illinois
  • 13Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
  • 14Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
  • 15School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill
  • 16Department of Oncology, Mayo Clinic, Rochester, Minnesota
  • 17Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
  • 18Department of Radiation Oncology, University of Michigan, Ann Arbor
  • 19Cancer and Aging Research Group
  • 20Dana-Farber Cancer Institute, Boston, Massachusetts
  • 21Alliance for Clinical Trials in Oncology, Boston, Massachusetts
  • 22Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
  • 23Division of General Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 24Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
  • 25Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
JAMA Oncol. Published online January 28, 2021. doi:10.1001/jamaoncol.2020.7582
Abstract

Importance  There is currently no guidance on how to approach surveillance mammography for older breast cancer survivors, particularly when life expectancy is limited.

Objective  To develop expert consensus guidelines that facilitate tailored decision-making for routine surveillance mammography for breast cancer survivors 75 years or older.

Evidence  After a literature review of the risk of ipsilateral and contralateral breast cancer events among breast cancer survivors and the harms and benefits associated with mammography, a multidisciplinary expert panel was convened to develop consensus guidelines on surveillance mammography for breast cancer survivors 75 years or older. Using an iterative consensus-based approach, input from clinician focus groups, and critical review by the International Society for Geriatric Oncology, the guidelines were refined and finalized.

Findings  The literature review established a low risk for ipsilateral and contralateral breast cancer events in most older breast cancer survivors and summarized the benefits and harms associated with mammography. Draft mammography guidelines were iteratively evaluated by the expert panel and clinician focus groups, emphasizing a patient’s risk for in-breast cancer events, age, life expectancy, and personal preferences. The final consensus guidelines recommend discontinuation of routine mammography for all breast cancer survivors when life expectancy is less than 5 years, including those with a history of high-risk cancers; consideration to discontinue mammography when life expectancy is 5 to 10 years; and continuation of mammography when life expectancy is more than 10 years. Individualized, shared decision-making is encouraged to optimally tailor recommendations after weighing the benefits and harms associated with surveillance mammography and patient preferences. The panel also recommends ongoing clinical breast examinations and diagnostic mammography to evaluate clinical findings and symptoms, with reassurance for patients that these practices will continue.

Conclusions and Relevance  It is anticipated that these expert guidelines will enhance clinical practice by providing a framework for individualized discussions, facilitating shared decision-making regarding surveillance mammography for breast cancer survivors 75 years or older.

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