18: Clinical Impact of Semi-Annual Mammography in Patients Undergoing Breast Conserving Surgery Following Neoadjuvant Therapy

Saturday, March 25, 2023

9:02 AM – 9:12 AM

Location: Veterans Memorial Auditorium

Abstract Presenter(s)

Ton Wang, MD

Breast Surgical Oncology Fellow
Cedars-Sinai Medical Center
Los Angeles, California, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Ton Wang, MD

Breast Surgical Oncology Fellow
Cedars-Sinai Medical Center
Los Angeles, California, United States

Disclosure(s): No financial relationships to disclose

Author(s)

Christina Weed, MD, MPH (she/her/hers)

Breast Surgical Oncology Fellow
Cedars-Sinai Medical Center, United States

Disclosure information not submitted.
JT

Joshua Tseng, MD

General Surgeon
Cedars-Sinai Medical Center - Los Angeles, CA, United States

Disclosure information not submitted.
Alice Chung, MD

Associate Professor of Surgery
Cedars Sinai Medical Center
Beverly Hills, California, United States

Disclosure(s): No financial relationships to disclose
AM

Alison Moody, MD, MPH

Attending Surgeon
Ascension Medical Group, United States

Disclosure information not submitted.
SG

Sara Grossi, MD

Assistant Professor of Surgery
University of California, San Diego, United States

Disclosure information not submitted.
MB

Marissa Boyle, MD

Attending Surgeon
Cedars Sinai Medical Center, United States

Disclosure information not submitted.
AG

Armando Giuliano, MD, FACS

Professor of Surgery
Cedars-Sinai Medical Center, United States

Disclosure information not submitted.
FA

Farin Amersi, MD

Associate Professor of Surgery
Cedars Sinai Medical Center
Los Angeles , California, United States

Disclosure information not submitted.

Disclosure(s):

Ton Wang, MD: No financial relationships to disclose

Alice Chung, MD: No financial relationships to disclose

Introduction: NCCN guidelines recommend annual surveillance mammography (MMG) for patients (pts) following breast conserving surgery (BCS) for invasive breast cancer (IBC). However, for pts treated with BCS following neoadjuvant therapy (NAT), the optimal frequency for surveillance imaging has not been established. Due to concern for potentially higher rates of in-breast recurrence after NAT, many institutions perform semi-annual imaging for 24 months (mo), followed by annual surveillance. The objective of this study is to assess the utility and costs of semi-annual MMG after BCS in pts treated with NAT.

Methods: We analyzed a prospective, single institution database of pts with IBC (cT1-T4, N0-N3, M0) who received BCS following NAT from 2007-2020. Clinicopathologic features, surveillance imaging, and outcomes were analyzed using Student’s T-test and Pearson’s Chi-square tests for statistical significance. Direct costs associated with imaging and biopsies were estimated based on Medicare Physician Fees.

Results: 139 pts received BCS following NAT, of which 60 (43%) had a pathologic complete response. At a median follow up of 65 mo (24-181 mo), 8 (6%) pts developed locoregional recurrences. Most pts received semi-annual diagnostic MMG for the first 24 mo after surgery (86%, 82%, 78%, and 75% of pts received a MMG at 6, 12, 18, and 24 mo, respectively). At 6 mo, 117 pts received a MMG which resulted in 29 (21%) pts requiring additional imaging (20 breast US and 9 breast MRIs) and 9 core-needle biopsies, all of which were benign. At 18 mo, 104 pts received a MMG which resulted in 35 (25%) pts requiring additional imaging (24 US and 11 MRIs) and 2 biopsies, of which 1 was malignant and 1 was benign. In total, in the first 24 mo after BCS, 20 (14%) pts underwent biopsy based on an abnormal surveillance MMG (9 at 6 mo, 5 at 12 mo, 2 at 18 mo, and 4 at 24 mo), but only 3 (2%) pts were found to have recurrent disease. The direct cost associated with semi-annual imaging and benign biopsies of pts in this cohort is $28,841 at 6 mo and $23,684 at 18 mo.

Conclusions: There is insufficient evidence to support semi-annual MMG surveillance in the first 24 mo following BCS in pts treated with NAT, and annual MMG with clinical breast exam is likely sufficient. Semi-annual MMG provides limited detection of locoregional recurrences but is associated with unnecessary benign biopsies, resulting in increased health care costs and patient distress. Extrapolated to the population level, avoiding semi-annual MMG has the potential for cost-savings in excess of $37 million per 100,000 pts treated with BCS following NAT.

Learning Objectives:

Upon completion, participants will be able to discuss national guidelines for imaging surveillance following BCS for IBC and how these apply to patients treated with neoadjuvant therapy prior to BCS.
Upon completion, participants will be able to discuss the risks versus benefits of semi-annual imaging surveillance following BCS in patients treated with neoadjuvant therapy for IBC.
Upon completion, participants will be able to discuss the potential for cost savings associated with avoiding unnecessary imaging and subsequent biopsies after BCS.