Individualizing Approaches to Surveillance Mammography in Older Breast Cancer Survivors

PROJECT SUMMARY/ABSTRACT

Evidence-based approaches to surveillance mammography for older breast cancer survivors do not exist. Data

suggest a life expectancy of ~10 years is necessary for early detection to translate into a small survival benefit.

Conversely, the harms of mammography persist and are immediate, including false positives, overdiagnosis,

and related over-treatment. Currently, mammography use in survivors is high, even when life expectancy is

limited. As part of a National Cancer Institute (NCI) R21, the “Are Mammograms Still Right for Me?” shared

decision making (SDM) toolkit was developed to support SDM between clinicians and older women around

when to discontinue surveillance mammography. The SDM toolkit is designed for any survivorship setting and

contains clinician-facing expert-consensus guidelines, talking points, and a companion patient guide on the

benefits and harms of surveillance mammography. What remains lacking and critically needed is evidence as

to the effectiveness of the SDM toolkit in decreasing mammography use in those who are more likely to experi-

ence harm than benefit. The long-term goal is to accelerate the development and implementation of breast

cancer survivorship guidelines tailored to individuals. The overall objective for this application is to determine

the effects of the SDM toolkit on mammography use, decision quality, and mammography knowledge in breast

cancer survivors aged ≥80, an age where median life expectancy is 50,000 women age ≥80 diagnosed with breast cancer annually in

the U.S. and the growing population of older breast cancer survivors.