Consensus guidelines recommending that routine surveillance mammography be discontinued for older breast cancer survivors with a limited life expectancy1 may raise questions among patients concerned about undetected cancer recurrence. Informing older survivors about the new recommendations and the potential benefits and drawbacks of mammography can help women choose whether or not to continue routine mammography.
“Some women will say, ‘Thank you very much, but I still want my mammograms,’” Rachel A. Freedman, MD, MPH, the lead author of the consensus statement, told The ASCO Post. “But there are some patients who will realize maybe they don’t need to have them anymore. They will feel liberated by that and can go and focus on other things.” Dr. Freedman is Medical Director of the Dana-Farber Cancer Institute Cancer Care Collaborative, Boston, and Associate Professor of Medicine at Harvard Medical School.
Empowering Both Clinicians and Patients
“We anticipate that these recommendations will provide a framework for clinicians to use in discussions with older breast cancer survivors and will facilitate an individualized approach to surveillance mammography and discontinuation,” the authors of the consensus statement wrote. “The goal of these guidelines is to give clinicians and patients some guidance,” Dr. Freedman added. “Clinicians, I hope, would feel empowered,” she continued, and let patients know what the guidelines call for and help them decide what is best for them.
Patients need to know that a decision to discontinue mammography is not irrevocable, Dr. Freedman said. Patients who decide to discontinue can later resume mammography. She noted, however, that “patients who stop rarely go back.”
Framing the Discussion
“How we frame these recommendations and patients’ understanding of the material are key factors,” Dr. Freedman said. An appendix to the consensus statement listed several talking points to share with patients, such as the following:
- Most of the breast cancers found on mammograms are slow-growing, and it can take years before these breast cancers affect one’s health.
- Women who have had (unilateral) mastectomy may have even less to gain from mammography, since the benefits are limited to the contralateral breast, which has been associated with very low breast cancer event rates over time.
- Some harms that may result from surveillance mammography include false-positive results, discomfort, overdiagnosis, and overtreatment.
The guidelines for clinicians will be complemented by printed materials that breast cancer survivors can use to assess their risk of breast cancer recurrence as well as to weigh the potential benefits and drawbacks of mammography with their health-care team. The guide for patients “is in its final phases,” Dr Freedman shared. “We are piloting it in the clinic with 40 patients and their providers and getting feedback on the guide.” Dr. Freedman predicted the patient guide will be available online sometime this year.
DISCLOSURE: Dr. Freedman has received institutional research funding from Eisai, Genentech/Roche, and Puma Biotechnology.
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