Expert Point of View: Elizabeth A. Morris, MD
Elizabeth A. Morris, MD
Elizabeth A. Morris, MD, Professor and Chair of the Department of Radiology at the University of California Davis, Sacramento, told The ASCO Post that the study by Berger et al addresses an important question. “This is a topic I am kind of passionate about—it addresses the ordering of mammograms as a knee-jerk reflex without thinking of the totality of the patient and what the patient may be currently battling,” she said, noting that she has often seen referrals for mammograms in patients with stage IV disease.
“The guidelines say that people who have a life expectancy of less than 10 years and who are over 75 years old should not be referred for mammography,” she pointed out. With some caveats and exceptions, she suggested these guidelines could be possibly extended to breast cancer survivors “above a certain age group.”
Scenario of Confusion
According to Dr. Morris, the overuse of surveillance mammography is part of a larger scenario of confusion surrounding appropriate follow-up after breast cancer treatment. In a 2018 survey, 73% of radiology practices recommended diagnostic (not standard) mammography surveillance after breast-conserving therapy, with intervals ranging from every 6 months to every 5 years before returning to regular screening mammograms.1
This was a common practice despite the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology stating that “annual mammography” is recommended and not specifying it be diagnostic or standard. The survey authors concluded there is “immense variability” in the application of the NCCN recommendations in clinical practice. “If treatment is successful, then annual screening mammography should be sufficient,” she said. n
DISCLOSURE: Dr. Morris reported no conflicts of interest.
1. Patel BK, Lee CS, Kosiorek HE, et al: Variability of postsurgical imaging surveillance of breast cancer patients: A nationwide survey study. AJR Am J Roentgenol 210:222-227, 2018.
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