The clinical effectiveness and cost-effectiveness of different surveillance mammography regimes after the treatment of primary breast cancer
Large numbers of women each year undergo treatment for breast cancer and many of these need long-term surveillance to identify new cases of cancer or recurrences. Currently, while much surveillance is conducted mammographically there is variation in how frequently these mammograms are performed and in how many years women are followed up. This evaluation examined the clinical effectiveness and cost-effectiveness of different surveillance mammography regimes after the treatment of primary breast cancer in the UK in primary and secondary care settings, using a combination of systematic reviews of diagnostic performance and relative effectiveness, patient-level analysis of large registry data sets collected in different regions of the UK and cost-effectiveness modelling.
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 with those at high risk 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 ipsilateral breast tumour recurrence or metachronous contralateral breast cancer is mammography only every three years.
Outcome and Translation
This project provided evidence regarding the most effective and cost-effective ways of following up women after primary breast cancer. The results of the project were disseminated in a series of peer-reviewed papers and keynote presentations as well as a lay summary. The report was made available to the working party on Breast Cancer surveillance for the National Screening Committee. The report has been referenced in the Royal College of Radiologists and the American Society of Clinical Oncology guidelines for breast cancer follow-up: http://www.rcr.ac.uk/publication/guidance-screening-and-symptomatic-breast-imaging-third-edition; http://www.asco.org/practice-guidelines/quality-guidelines/guidelines/breast-cancer#/9821).
HERU researchers involved in this research project: Rodolfo Hernández, Luke Vale and Laura Ternent
External collaborators: F Gilbert (Clinical Services, University of Aberdeen); JM Dixon (Western General Hospital); SE Pinder, ARM Wilson (King’s College London); GS MacLennan, R Thomas, C Fraser, J Burr (HSRU, University of Aberdeen); RW Blamey (Nottingham City Hospital); and SD Heys (Division of Applied Medicine, University of Aberdeen)
Robertson, C., Boachie, C., Dixon, M., Fraser, C., Hernández, R., Heys, S., Jack, W., Kerr, G., Ragupathy, S., Lawrence, G., MacLennan, G., Maxwell, A., McGregor, J., Mowatt, G., Pinder, S., Ternent, L., Thomas, R., Vale, L., Wilson, R., Zhu, S. and Gilbert, F. (2010) The clinical effectiveness and cost-effectiveness of different surveillance mammography regimes after the treatment of primary breast cancer. Final Report Submitted to NIHR HTA Programme, National Institute of Health Research.
Robertson, C., Ragupathy, S.K.A., Boachie, C., Dixon, J.M., Fraser, C., Hernández, R., Heys, S., Jack, W., Kerr, G.R., Lawrence, G., MacLennan, G., Maxwel, A., McGregor, J., Mowatt, G., Pinder, S., Ternent, L., Thomas, R.E., Vale, L., Wilson, R., Zhu, S. and Gilbert, F.J. (2011) '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 technology Assessment, 15(34), 1-322.
Vale, L. (2008) 'HTA of Surveillance Mammography after treatment for Primary Breast Cancer', Scottish Breast Cancer Research Group Meeting, Dundee, October 2008.
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