A substantive NIHR HTA commissioned project to examine the clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment of primary breast cancer in the UK in primary and secondary care settings. We conducted:
1. A survey of UK breast surgeons and radiologists to identify current practice and estimate resource consequences of the varying regimes.
2. A series of systematic reviews to determine the clinical effectiveness and cost-effectiveness of differing surveillance mammography regimes after treatment for breast cancer on the detection of ipsilateral breast tumour recurrence, metachronous contralateral breast cancer and on patient health outcomes.
3. Statistical and economic modelling using the results of the systematic reviews and analysis of individual patient data from identified primary datasets to determine the effectiveness, cost-consequences and cost-utility of differing surveillance regimes.
The project concluded that surveillance is likely to improve survival with a strategy of mammography alone every 12 to 24 months appearing to have the highest net benefits. The evidence base on which to recommend any change in current practice is relatively weak, however. Careful consideration should be given to stratification of patients to ensure maximum benefit to ensure optimal use of resources with those women with a greater likelihood of developing IBTR or MCBC being offered more comprehensive (e.g. mammography and clinical follow-up) and more frequent surveillance (every 12 months). The greatest net benefit for women with the lowest likelihood of IBTR or MCBC is mammography only every 3 years.
Clare Robertson; firstname.lastname@example.org
Robertson C, Arcot Ragupathy S, Boachie C, Dixon J, Fraser C, Hernandez R, et al. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews, registry database analyses and economic evaluation. Health Technol Assess 2011;15(34). http://www.journalslibrary.nihr.ac.uk/hta/volume-15/issue-34
Robertson C, Arcot Ragupathy SK, Boachie C, Fraser C, Heys S, MacLennan G, Mowatt G, Thomas R, Gilbert FJ and the Mammographic Surveillance Health Technology Assessment Group. Surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer: A systematic review. European Radiology 2011, 21 (12) 2484-2491