Expert Consensus Guidelines for Surveillance Mammography for Older Breast Cancer Survivors

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To date, decisions about surveillance mammography for older breast cancer survivors have generally not been influenced by clinical guidelines, especially when life expectancy is limited.

Recently, expert consensus guidelines were developed to assist with tailored decision-making for routine surveillance mammography for breast cancer survivors who are ≥75 years of age.

A multidisciplinary expert panel was assembled to produce consensus guidelines on surveillance mammography for breast cancer survivors aged ≥75 years. This undertaking was based on an extensive review of the literature focused on the risk of contralateral and ipsilateral breast cancer events among breast cancer survivors, as well as the advantages and drawbacks linked with mammography. The guidelines were developed based on an iterative consensus-based methodology, feedback from clinician focus groups, and critical analysis by the International Society of Geriatric Oncology.

The benefits and harms associated with mammography were summarized, based on a literature review that established a low risk for ipsilateral and contralateral breast cancer events in most older breast cancer survivors. The expert panel and clinician focus groups iteratively evaluated the draft mammography guidelines, focusing on a patient’s risk for breast cancer events, age, personal preferences, and life expectancy.

The expert panel proposed several final consensus guideline recommendations, including cessation of routine mammography for all breast cancer survivors when life expectancy is <5 years, including patients with a history of high-risk cancers. When life expectancy ranges between 5 and 10 years, clinicians should consider discontinuing mammography. When life expectancy is >10 years, the guidelines recommend continuing surveillance with mammography.

Overall, clinicians should weigh the benefits and harms associated with surveillance mammography as well as patient preferences to create tailored recommendations through shared decision-making. Additionally, the panel recommended to continue with ongoing clinical breast examinations and appropriate diagnostic mammography to evaluate clinical findings and symptoms. Patients should be reassured that these practices will continue.

These recommendations provide a clear structure for discussions that will enhance clinical practice by assisting with shared decision-making regarding surveillance mammography for breast cancer survivors who are ≥75 years of age.

Source

Freedman RA, Minami CA, Winer EP, et al. Individualizing surveillance mammography for older patients after treatment for early-stage breast cancer: multidisciplinary expert panel and International Society of Geriatric Oncology consensus statement. JAMA Oncol. Published online ahead of print January 28, 2021. doi: 10.1001/jamaoncol.2020.7582.

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