@article{d414a021ad4444d0a74f708f91a4f35c,
title = "Individualizing Surveillance Mammography for Older Patients after Treatment for Early-Stage Breast Cancer: Multidisciplinary Expert Panel and International Society of Geriatric Oncology Consensus Statement",
abstract = "Importance: There is currently no guidance on how to approach surveillance mammography for older breast cancer survivors, particularly when life expectancy is limited. Objective: To develop expert consensus guidelines that facilitate tailored decision-making for routine surveillance mammography for breast cancer survivors 75 years or older. Evidence: After a literature review of the risk of ipsilateral and contralateral breast cancer events among breast cancer survivors and the harms and benefits associated with mammography, a multidisciplinary expert panel was convened to develop consensus guidelines on surveillance mammography for breast cancer survivors 75 years or older. Using an iterative consensus-based approach, input from clinician focus groups, and critical review by the International Society for Geriatric Oncology, the guidelines were refined and finalized. Findings: The literature review established a low risk for ipsilateral and contralateral breast cancer events in most older breast cancer survivors and summarized the benefits and harms associated with mammography. Draft mammography guidelines were iteratively evaluated by the expert panel and clinician focus groups, emphasizing a patient's risk for in-breast cancer events, age, life expectancy, and personal preferences. The final consensus guidelines recommend discontinuation of routine mammography for all breast cancer survivors when life expectancy is less than 5 years, including those with a history of high-risk cancers; consideration to discontinue mammography when life expectancy is 5 to 10 years; and continuation of mammography when life expectancy is more than 10 years. Individualized, shared decision-making is encouraged to optimally tailor recommendations after weighing the benefits and harms associated with surveillance mammography and patient preferences. The panel also recommends ongoing clinical breast examinations and diagnostic mammography to evaluate clinical findings and symptoms, with reassurance for patients that these practices will continue. Conclusions and Relevance: It is anticipated that these expert guidelines will enhance clinical practice by providing a framework for individualized discussions, facilitating shared decision-making regarding surveillance mammography for breast cancer survivors 75 years or older..",
author = "Freedman, {Rachel A.} and Minami, {Christina A.} and Winer, {Eric P.} and Monica Morrow and Smith, {Alexander K.} and Walter, {Louise C.} and Sedrak, {Mina S.} and Haley Gagnon and Adriana Perilla-Glen and Hans Wildiers and Wildes, {Tanya M.} and Lichtman, {Stuart M.} and Loh, {Kah Poh} and Brain, {Etienne G.C.} and Ganschow, {Pamela S.} and Hunt, {Kelly K.} and Mayer, {Deborah K.} and Ruddy, {Kathryn J.} and Reshma Jagsi and Lin, {Nancy U.} and Beverly Canin and Lestage, {Barbara K.} and Revette, {Anna C.} and Schonberg, {Mara A.} and Keating, {Nancy L.}",
note = "Funding Information: Conflict of Interest Disclosures: Dr Freedman reported receiving clinical trial funding to the institution from Puma Biotechnology and Eisai outside the submitted work. Dr Winer reported receiving grants from AstraZeneca and Genentech/ Roche; and personal fees from Carrick Therapeutics, G1 Therapeutics, Genentech/Roche, Genomic Health, GSK, Jounce, Leap, Lilly, Novartis, Seattle Genetics, Syros, and Zymeworks outside the submitted work. Dr Morrow reported receiving personal fees from Genomic Health outside the submitted work. Dr Wildes reported serving as institutional principal investigator for Janssen Research and receiving personal fees from Seattle Genetics and Carevive outside the submitted work. Dr Loh reported serving as a consultant for Pfizer and Seattle Genetics outside the submitted work. Dr Brain reported receiving personal fees from Samsung, Pfizer, Roche, Mylan, BMS, TLC, G1 therapeutics, and Eli Lilly and travel and accommodation expenses from Pierre Fabre, AstraZeneca, and Novartis outside the submitted work. Dr Hunt reported serving on the medical advisory board for Armada Health and Merck & Co and receiving grants from Endomagnetics Research to the institution, grants from Lumicell Research to the institution, and grants from OncoNano Research to the institution outside the submitted work. Dr Mayer reported serving as an advisor for and being a stockholder of Carevive outside the submitted work. Dr Jagsi reported receiving grants from the National Institutes of Health (NIH), Doris Duke Charitable Foundation, Komen Foundation, Greenwall Foundation, Genentech, and Blue Cross Blue Shield of Michigan; personal fees from Vizient, Sherinian & Hasso, and Dressman, Benzinger, LaVelle; stock options for service as an advisor from Equity Quotient outside the submitted work; and is an uncompensated founding member of TIME{\textquoteright}S UP Healthcare and member of the Board of Directors of ASCO. Ms Canin reported receiving personal fees and expenses from Dana-Farber Cancer Institute for serving as a consultant during the conduct of the study and personal fees from City of Hope Comprehensive Cancer Center for serving as a consultant outside the submitted work. Dr Schonberg reported receiving grants from the National Cancer Institute (NCI) during the conduct of the study. Dr Keating reported receiving grants from the NCI during the conduct of the study. No other disclosures were reported. Funding Information: Funding/Support: This study was supported by grant NIH/NCI R21CA227615-01A1 from the NCI (Dr Freedman), grant CCRCR18552788 from Susan G. Komen (Dr Freedman), grant MRSG-14-240-01-CPPB from the American Cancer Society (Dr Freedman), NIH/NCI Cancer Center Support Grant P30 CA00874.8 (Dr Lichtman), and NIH/NIA (National Institute on Aging) Older Adults Independence Center grant P30 AG044281 (Dr Walter). Publisher Copyright: {\textcopyright} 2021 AMA. All rights reserved.",
year = "2021",
month = apr,
doi = "10.1001/jamaoncol.2020.7582",
language = "English (US)",
volume = "7",
pages = "609--615",
journal = "JAMA Oncology",
issn = "2374-2437",
publisher = "American Medical Association",
number = "4",
}