Surveillance Mammography Research Articles

Surveillance mammography after treatment for male breast cancer.

To identify the practice patterns related to use of surveillance mammography in male breast cancer (MaBC) survivors. Using administrative claims data from OptumLabs Data Warehouse, we identified men who underwent surgery for breast cancer during 2007-2017. We calculated the proportion of men who had at least one mammogram (a) within 13months for all patients and (b) within 24months amongst those who maintained their insurance coverage for at least that length of time after surgery. Multivariate logistic regression modeling was used to identify factors associated with mammography within each timeframe. Out of 729 total MaBC survivors, 209 (29%) underwent mammography within 13months after surgery. Among those who had lumpectomy, 41% underwent mammography, whereas among those who had mastectomy, 27% had mammography. Amongst 526 men who maintained consistent insurance coverage for 24months after surgery, 215 (41%) underwent mammography at least once during that 24-month period. In this cohort, the proportion who had at least one mammogram during the 24-month period was 49% after lumpectomy and 40% after mastectomy. In a multivariate logistic regression model, more recent diagnosis (2015+) and older age at diagnosis were associated with lower odds of undergoing mammography, while receipt of radiation was associated with higher odds of undergoing mammography. Although recent ASCO guidelines recommend surveillance mammography after lumpectomy, a minority of MaBC survivors undergo surveillance mammography, even after lumpectomy. This is likely due to the paucity of data regarding the true benefits and harms of surveillance/screening mammography for MaBC.

When to stop? Mammographic surveillance in breast cancer survivors aged 70 years and older

To assess the rates of breast cancer detected in postoperative surveillance mammograms in women >70 Years and overall mortality in this age group. Four hundred and ninety-eight patients were identified retrospectively from a database from a single large UK hospital. Patients were included in the study if they were female, aged >70 years at diagnosis of either invasive breast cancer or ductal carcinoma in situ (DCIS), had surgical treatment between 1 January 2010 and 31 December 2014, and no previous diagnosis of breast cancer. Statistical analysis was performed using Excel, using the X2 test, with p≤0.05 considered statistically significant. The mean age of women included in this study was 77 years. The mean number of postoperative surveillance mammograms performed per patient was 4.2. In the 5-year follow-up, there was a local recurrence rate of 1.9% (n=6) and a contralateral breast cancer rate of 1% (n=6). The 5-year overall mortality rate was 17.7% (n=88), and the 5-year breast cancer-specific mortality rate was 7.2% (n=36). This study demonstrated low local recurrence and contralateral breast cancer rates during the 5-year follow-up period. Clear discussions therefore need to be held with older patients about the value of postoperative mammographic surveillance. Further research is required regarding patient opinion and experience to help develop more consistent guidelines.

Mammographic surveillance for contralateral breast cancer: A single centre retrospective study

Introduction: After mastectomy, breast cancer patients undergo mammographic surveillance to detect contralateral breast cancer (CBC). There are no national guidelines for this. At our centre, women under 50 at the time of mastectomy have annual mammograms until age 50 and then enter the national screening programme. Women over 50 have annual mammograms for 5 years after which they re-enter the national screening programme.

Utilization of Mammography During the Last Year of Life Among Older Breast Cancer Survivors.

Background: Mammography is generally recommended for breast cancer survivors. However, discussion is ongoing about stopping surveillance mammography when life expectancy is <5-10 years as the benefit of screening might be diminished toward the end of life. The utilization pattern of mammography in the last year of life among this population has not been well studied. Methods: We identified 58,736 females diagnosed with breast cancer between January 2002 and December 2015, who died at the age of at least 67, from the SEER-Medicare database. We examined the utilization patterns of mammography during their last year of life and investigated factors associated with the use of mammography at the end of life using a multivariable logistic regression model. Results: Overall, 28.5% of the patients received mammography during the last year of life. Multivariable logistic regression showed that older age (OR = 0.31, 95% CI = 0.29-0.34, p < 0.001 for 95 vs. 85 years old), more advanced cancer stage (OR = 0.22, 95% CI = 0.20-0.24 p < 0.001 for distant vs. localized disease), and higher comorbidity score (OR = 0.92, 95% CI = 0.91-0.93, p < 0.001 for every 1-point increase) were associated with less mammography use. Age was nonlinearly associated with mammography use, with a steady proportion of patients receiving a mammography until approximately age 80 and then a sharp decrease thereafter. Conclusion: This population-based study found that a sizable proportion of older breast cancer survivors received mammography during the last year of life.

Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016.

Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40-49 vs 50-64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, -3.4% to -2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, -1.9% to -1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, -1.7%; 95% CI, -2.1% to -1.4%) or a primary care provider (APC, -1.6%; 95% CI, -2.1% to -1.2%) in the prior year. Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.

BPI22-021: Surveillance Mammography in Elderly Breast Cancer Survivors (Project Funded by Breast Cancer Research Foundation)

BPI22-021: Surveillance Mammography in Elderly Breast Cancer Survivors (Project Funded by Breast Cancer Research Foundation)

Population DNA screening for medically actionable disease risk in adults

Population DNA screening for medically actionable disease risk in adults

Variability of Mammographic Imaging Surveillance in Breast Cancer Survivors.

Variability of Mammographic Imaging Surveillance in Breast Cancer Survivors.

Mammographic Surveillance After Breast-Conserving Therapy: Impact of Digital Breast Tomosynthesis and Artificial Intelligence-Based Computer-Aided Detection.

BACKGROUND. Postoperative mammograms present interpretive challenges due to postoperative distortion and hematomas. The application of digital breast tomosyn-thesis (DBT) and artificial intelligence-based computer-aided detection (AI-CAD) after breast-conserving therapy (BCT) has not been widely investigated. OBJECTIVE. The purpose of our study was to assess the impact of additional DBT or AI-CAD on recall rate and diagnostic performance in women undergoing mammographic surveillance after BCT. METHODS. This retrospective study included 314 women (mean age, 53.3 ± 10.6 [SD] years; four with bilateral breast cancer) who underwent BCT followed by DBT (mean interval from surgery to DBT, 15.2 ± 15.4 months). Three breast radiologists independently reviewed images in three sessions: digital mammography (DM), DM with DBT (DM plus DBT), and DM with AI-CAD (DM plus AI-CAD). Recall rates and diagnostic performance were compared between DM, DM plus DBT, and DM plus AI-CAD using the readers' mean results. RESULTS. Of the 314 women, six breast recurrences (three ipsilateral and three contralateral) had developed at the time of surveillance mammography. The ipsilateral breast recall rate was lower for DM plus AI-CAD (1.9%) than for DM (11.2%) or DM plus DBT (4.1%) (p < .001). The contralateral breast recall rate was significantly lower for DM plus AI-CAD (1.5%, p < .001) than for DM (6.6%) but for not DM plus DBT (2.7%, p = .08). In the ipsilateral breast, accuracy was higher for DM plus AI-CAD (97.0%) than for DM (88.5%) or DM plus DBT (94.8%) (p < .05); specificity was higher for DM plus AI-CAD (98.3%) than for DM (89.3%) or DM plus DBT (96.1%) (p < .05); sensitivity was significantly lower for DM plus AI-CAD (22.2%) than for DM (66.7%, p = .03) but not DM plus DBT (22.2%, p > .99). In the contralateral breast, accuracy was significantly higher for DM plus AI-CAD (97.1%) than for DM (92.5%, p < .001) but not DM plus DBT (96.1%, p = .25); specificity was significantly higher for DM plus AI-CAD (98.6%) than for DM (93.7%, p < .001) but not DM plus DBT (97.5%) (p = .09); sensitivity was not different between DM (33.3%), DM plus DBT (22.2%), and DM plus AI-CAD (11.1%) (p > .05). CONCLUSION. After BCT, adjunct DBT or AI-CAD reduced recall rates and improved accuracy in the ipsilateral and contralateral breasts compared with DM. In the ipsilateral breast, the addition of AI-CAD resulted in a lower recall rate and higher accuracy than the addition of DBT. CLINICAL IMPACT. AI-CAD may help address the challenges of interpreting post-BCT surveillance mammograms.

Disparities Associated With Patient Adherence of Post-Breast-Conserving Surgery Surveillance Imaging Protocols.

Currently, national and international breast imaging practices utilize variable postsurgical surveillance protocols without uniform recommendations. Because of the innate differences between screening versus diagnostic mammography from scheduling flexibility to out-of-pocket costs, this creates the opportunity for lapses in patient adherence, which has the potential to impact clinical outcomes. The purpose of this study is to evaluate the relationship between sociodemographic factors and postsurgical surveillance imaging protocols on patient adherence rates. This retrospective study reviewed 3 years of surveillance imaging for all patients having breast-conserving surgery at our institution from January 2011 to December 2016. Follow-up adherence was defined as returning for all of the first 3 years of annual follow-up after breast-conserving surgery (institutional surveillance protocol). Associations between adherence to surveillance imaging and patient sociodemographic characteristics were evaluated using univariate and multivariate logistic regression. The study included 1,082 patients after breast surgery, 715 of whom adhered completely to the first 3 years of annual follow-up (66.1%). Black women were 1.36 times less likely to follow up annually compared with White women (95% confidence interval 1.02-1.80). Similarly, patients with Medicare were 1.84 times less likely to follow up annually compared with patients with private insurance (95% confidence interval 1.34-2.51). Women with benign breast disease after breast-conserving surgery were significantly less likely to adhere to annual surveillance than women with breast cancer. Sociodemographic disparities exist as barriers for annual mammography surveillance in patients after breast-conserving surgery.

EP.TH.803VAE for Breast Lesions of Uncertain Potential (B3) -A Quality Improvement Project

Abstract Aims Breast lesions of uncertain malignant potential (B3) account for 7% breast lesions biopsied. Management has been controversial and challenging for the MDT. Aim of the study was to compare current NHS BSP guidelines with our trust’s practice and the secondary outcome was a shorter patient pathway and cost effectiveness. Methods As per NHS BSP guidelines VAE should be performed for all B3 lesions diagnosed on 14g or vacuum assisted biopsy. We were referring them to other NHS trusts as there were no in-house facilities or doing an excisional biopsy if no resources for VAE available. From September 2019 VAEs started to be done by in-house consultant breast radiologist after getting the appropriate training and instruments. Data was collected from September 2019 to August 2020 for all patients. Results 22 VAEs were performed in one year. Out of those 6 (27.2%) were upgraded to malignancy and needed further surgery, 2 (9%) with atypia had 5 years mammographic surveillance and 14 (63%) were discharged including sclerosing lesions, radial scars, fibrosis and chronic inflammation. The cost of VAE in our hospital is £1330 vs. £2439 for Wire Guided wide local excision. This makes it cost effective. Conclusion We were following the VAE protocol as per NHS BSP guidelines. Despite added workload to radiology VAE is minimally invasive, safe and cost effective alternative to surgery providing thorough MDT discussion has taken place. Greater benefit was provided to patient as all VAEs were performed in radiology department avoiding general Anaesthesia and surgical trauma.

SP8.1.5 Breast cancer follow up; Is routine mammography indicated?

Abstract Aim This paper aims to review the outcome from yearly mammography in detecting breast cancer recurrence and new primary tumours in patients with a history of breast cancer. Methods From 2014, following treatment for breast cancer, patients were enrolled in a program of self-directed aftercare (SDA). They were given open access to the Breast service. Regular planned appointments were not offered. All patients underwent annual mammography for 5 years. Retrospective analysis of the SDA database from 2014 to 2016 was undertaken, time to and mechanism of detection of breast cancer recurrence in this population was determined. Results 352 patient records were analysed (1760 mammograms), 29 recurrences were identified. 12 locoregional, 12 systemic, 5 locoregional and systemic. Median time to diagnosis of recurrence was 30 months. Locoregional recurrence was detected by surveillance mammography (4 patients), clinical examination following patient request (7 patients), non-breast radiological investigation (5), by non-breast cancer care Doctors (1). No contralateral cancers were detected in patients who had mastectomy or WLE. Conclusion Despite limited evidence for regular clinical assessment post breast cancer treatment, the practice remains recommended. In this study regular clinical review was replaced by open access. Annual mammography was retained. Mammographic value out-with detection of malignancy (new/recurrent) was not assessed. The number of tumours detected (4 out of 1760 mammograms) would suggest that non-stratified routine mammography is of limited value for most patients. Further study is required to determine the risk or value and the cost/benefit analysis of mammographic follow up of breast cancer.

1417 Post-Operative Breast Cancer Surveillance: The Crucial Role of Timing in Effective ‘Track and Trace’

Abstract Aim The aim of this quality improvement project is to assess our centre’s compliance to current NICE guidelines regarding annual mammogram follow-up for every breast cancer patient for 5 years and to elucidate any mechanisms that may optimise the efficiency of this surveillance process. Method We prospectively reviewed individual radiology requests following all wire-guided wide local excisions (WG-WLE), wide local excisions (WLE) and mastectomies undertaken at Bristol Breast Centre, a large tertiary referral centre, from January 2017-August 2020. Results Over the almost 4-year audit period, 1,885 operations were carried out. Specifically, 401 operations were performed from January 2017-June 2017, 677 from July 2017-January 2019 and 807 from February 2019-August 2020. Compliance to NICE guidelines was 95%, 100% and 95% from January 2017-June 2017, July 2017-January 2019 and February 2019-August 2020, respectively. Interestingly, compliance rates from February 2019-August 2020 varied according to the type of operation carried out; compliance was 97%, 94% and 91% for WG-WLE, WLE and mastectomy, respectively. This appears to result from the corresponding number of tardy radiological requests that were made following each of the three procedures. Specifically, the proportion of database requests filed in excess of one month post-operatively for each procedure type were 8%, 10% and 21% for WG-WLE, WLE and mastectomy, respectively. Conclusions Efficient annual mammographic surveillance depends on prompt post-operative radiological requests. Such database requests should ideally be enacted less than one month post-operatively. We suggest the adoption of an automatic electronic prompt could facilitate more effective post-operative mammogram surveillance.

Diagnostic Versus Screening Mammography Recommendations for Postlumpectomy Imaging Surveillance of Patients With Breast Cancer.

Among 707 women who were recommended to undergo annual diagnostic mammography (DM) surveillance after lumpectomy for breast cancer, 94.9%, 90.4%, and 84.3% of women presented for DM at years 1, 2, and 3 after lumpectomy. A total of 18.8%, 11.0%, and 9.9% of women received additional views at years 1, 2, and 3, compared with the 10.1% institutional screening recall rate. The postlumpectomy year 3 cancer detection rate of 11.7 cancers per 1000 DM examinations was below DM benchmarks. These preliminary findings suggest that returning to screening mammography may be acceptable after 1 year of postlumpectomy DM follow-up.

Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007-2016.

Background Since 2007, digital mammography and digital breast tomosynthesis (DBT) replaced screen-film mammography. Whether these technologic advances have improved diagnostic performance has, to the knowledge of the authors, not yet been established. Purpose To evaluate the performance and outcomes of surveillance mammography (digital mammography and DBT) performed from 2007 to 2016 in women with a personal history of breast cancer and compare with data from 1996 to 2007 and the performance of digital mammography screening benchmarks. Materials and Methods In this observational cohort study, five Breast Cancer Surveillance Consortium registries provided prospectively collected mammography data linked with tumor registry and pathologic outcomes. This study identified asymptomatic women with American Joint Committee on Cancer anatomic stages 0-III primary breast cancer who underwent surveillance mammography from 2007 to 2016. The primary outcome was a second breast cancer diagnosis within 1 year of mammography. Performance measures included the recall rate, cancer detection rate, interval cancer rate, positive predictive value of biopsy recommendation, sensitivity, and specificity. Results Among 32 331 women who underwent 117 971 surveillance mammographic examinations (112 269 digital mammographic examinations and 5702 DBT examinations), the mean age at initial diagnosis was 59 years ± 12 (standard deviation). Of 1418 second breast cancers diagnosed, 998 were surveillance-detected cancers and 420 were interval cancers. The recall rate was 8.8% (10 365 of 117 971; 95% CI: 8.6%, 9.0%), the cancer detection rate was 8.5 per 1000 examinations (998 of 117 971; 95% CI: 8.0, 9.0), the interval cancer rate was 3.6 per 1000 examinations (420 of 117 971; 95% CI: 3.2, 3.9), the positive predictive value of biopsy recommendation was 31.0% (998 of 3220; 95% CI: 29.4%, 32.7%), the sensitivity was 70.4% (998 of 1418; 95% CI: 67.9%, 72.7%), and the specificity was 98.1% (114 331 of 116 553; 95% CI: 98.0%, 98.2%). Compared with previously published studies, interval cancer rate was comparable with rates from 1996 to 2007 in women with a personal history of breast cancer and was higher than the published digital mammography screening benchmarks. Conclusion In transitioning from screen-film to digital mammography and digital breast tomosynthesis, surveillance mammography performance demonstrated minimal improvement over time and remained inferior to the performance of screening mammography benchmarks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Moy and Gao in this issue.

Racial/ethnic disparities in use of surveillance mammogram among breast cancer survivors: a systematic review.

Increasing number of breast cancer survivors in the USA have led to greater focus on the long-term health outcomes and surveillance care among these women. However limited evidence exists of use of surveillance mammography among breast cancer survivors and how it varies across racial/ethnic groups. We conducted a systematic review of the literature to explore disparities in use of surveillance mammogram among women breast cancer survivors by searching for relevant studies published between 2000 and 2020 from Medline (Ovid), PubMed (National Library of Medicine), and PsycINFO (Ovid) bibliographic databases. Two authors independently screened titles, abstracts, and full texts of all articles that reported surveillance mammography use across racial/ethnic groups. Data on study design, screening eligibility, sample size, operational definition, and/or measure of the use of a surveillance mammogram among breast cancer survivors and the association between race/ethnicity and use of a surveillance mammogram were summarized in the evidence tables. We identified 1544 records from the three databases, and 30 studies examined the use of surveillance mammograms among breast cancer survivors across race/ethnic groups. Of these, 21 provided adjusted estimates of racial/ethnic disparities in use of surveillance mammograms, and 15 of these reported statistically significant disparities. In summary, most studies reported that non-white women (mainly Blacks and Hispanics) were less likely to receive a timely surveillance mammogram compared to White. This study extends the evidence of racial/ethnic disparities beyond completion of initial treatment by finding similar disparities in receipt of surveillance mammograms among breast cancer survivors. Our findings identify a need to improve efforts to increase post-treatment use of surveillance mammography among racial/ethnic minority women to reduce these gaps and improve overall clinical and quality of life outcomes.

Strong Beliefs and Soft Evidence Underlying Mammography Surveillance Recommendations in Breast Cancer Survivors: A Study in Reflexive Science and Decision-Making

Breast cancer is the most common cancer in women worldwide and more recently it has overtaken lung cancer as the world’s mostly commonly-diagnosed cancer, according to statistics released by the International Agency for Research on Cancer (IARC) in December 2020 Mammograph screening has been widely used as screening modality and been shown in reduce mortality. Although, benefit of screening mammography in healthy woman cannot be denied, extrapolating this evidence from screening experience in healthy individuals may be unrepresentative and erroneous. Continued mammographic surveillance of breast cancer survivors (BCSS) as of now continued to be standard of care even though still an unsettled issue in survivorship care due to the absence of high-level evidence supporting this current practice. Besides the fact that data regarding efficacy of mammography in BCSS is unclear, there are other concerns regarding its use. Considering, mammography is associated with false positive results requiring additional evaluations, overdiagnosis leading to needless treatment, psychological distress, physical discomfort and significant health-care expenditure, understanding the risk-benefit ratio of mammography in BCSS is crucial. Appropriate studies evaluating mammographic surveillance in BCSS are necessary to assess survival outcomes, costbenefit ratios and to identify subgroups that derive significant benefit. This holds the key to avoiding unwanted harm to our patients as well as unnecessary financial burden on health-care services.

The effectiveness of mammography surveillance after treatment of primary breast cancer: A single centre retrospective cohort study

IntroductionThere is a little evidence that routine follow-up of patients treated for early breast cancer (BC) to detect ibsilateral breast tumour recurrence (IBTR), or contralateral breast cancer (CBC), is either effective or offers any mortality benefits. We report our experience of following patients with early BC for recurrences and new primaries in order to determine the role of mammogram surveillance.MethodsSingle centre, retrospective primary observational study was designed. Patients who had BC during year 2001–2006 were included and followed for a minimum of ten years. Patients were divided based on the modalities of detecting BC in to screen detected group and clinically detected one i.e. symptomatic BC. These two groups were compared.ResultsTotal number of patients considered for analysis was 2530 (screen detected BC - 703 patients and symptomatic BC - 1827 patients). The rate of recurrence including regional and distant metastasis in screen detected BC group was 8% (57/703) and 2% (43/1827) in symptomatic one. However, the prevalence of IBTR/CBC in the whole cohort was 2% (62/2530). Mammography surveillance identified 60% (37/62) of patients who had IBTRs/CBCs.Mammography surveillance detected 85% (29/34) of all IBTRs/CBCs in the screen detected BC group. In contrast, it picked up only 29% (8/28) in the other group (Chi squared 20.5 p < 0.005).ConclusionsMammography surveillance is efficient for the screen detected BC group but not for the symptomatic one. Hence, it is worth suggesting different follow-up strategies for both groups. Further studies are therefore recommended.

Mammographic Surveillance in Older Women With Breast Cancer in Canada and the United States: Are We Choosing Wisely?

PurposeGuidelines on mammographic surveillance after breast cancer treatment have been disseminated internationally and incorporated into Choosing Wisely recommendations to reduce low-value care. However, adherence within different countries before their publication is unknown. Methods and MaterialsLow-value mammography, defined as “short-interval” (within 6 months of radiation) or “high-frequency” (>1 within 12 months of radiation), was compared in Medicare fee-for-service in the United States and Ontario, Canada. Women ≥65 years diagnosed with breast cancer who underwent breast-conserving therapy with a minimum of 24 months of follow-up were included (n = 19,715 United States; 6479 Ontario). Secondary outcomes were patient and physician characteristics associated with discordance. ResultsShort-interval mammography was higher in the United States than in Ontario (55.9% vs 38.0%, P < .001), as was high-frequency (39.6% vs 7.9%, P < .001). In Ontario, younger age (42% ≥85 vs 58% <74 years, P < .001) and chemotherapy (69% vs 51%, P < .001) were associated with short-interval mammography; in the United States, age, earlier diagnosis year, stage, chemotherapy, rurality, and academic center treatment were associated with greater use. Chemotherapy was associated with high-frequency mammography in both countries (13% vs 7% in Ontario, P < .001; 69% vs 51% in United States, P = .02); younger age, earlier diagnosis year, stage, and nonacademic center treatment were associated in the United States. In both countries, radiation oncologists had the highest proportion of providers ordering low-value mammograms. ConclusionsDespite significant evidence guiding surveillance mammography recommendations, there are high rates of short-interval mammography in both the United States and Ontario, and high rates of high-frequency mammography in the United States. Further international efforts, such as Choosing Wisely, are needed to reduce low-value mammography.

Abstract PS7-57: Patient risk factors for loss to breast oncologic follow up

Abstract For patients who complete treatment for breast cancer, national oncologic guidelines recommend yearly mammography surveillance and oncology follow-up especially during the first five years of survivorship. Some studies have shown that older age and insurance type may be risk factors for timely initial follow up after abnormal mammogram however the role in which racial and socioeconomic disparities may contribute to long term non-adherence or loss to follow-up (LTFU) is not known. Investigation into causes of LTFU or non-receipt of recommended surveillance are crucial in improving health care delivery and targeting interventions that prevent LTFU in high-risk patients. An ongoing study at Lifespan Breast Oncology aims to evaluate this issue further among patients treated for stage 1-3 breast cancer. We have completed data collection on 139 of 300 eligible patients diagnosed in 2014 and for whom 5 years of follow up have been completed. We measured adherence to yearly mammography, visit with breast oncologist, continuation of ET, and LTFU in each year of survivorship. LTFU was defined as patient without any further contact with the Lifespan Breast Oncology clinic. We then examined the association between these adherence measures and age, ECOG performance status at diagnosis, Medicaid insurance status, socio-economic factors, and specific adjuvant therapies, using univariate and multivariate generalized estimating equation models for longitudinal data. The models reported odds ratios (OR) for non-adherence or LTFU, with 95% confidence intervals (CI). Patients who experienced relapse or death were removed from the pool in the year of event. Adherence decreased for all measures between year 1 and year 5 of survivorship: from 99% to 82% for oncology visits, 92% to 80% for mammography, and 86% to 71% from ET. LTFU increased from 0% to 17%, respectively (OR per year, 1.96; 95%CI, 1.55-2.48). In univariate analysis, patients age &amp;gt;70 (compared with age ≤50) had a significantly higher risk of LTFU (Table), non-adherence to visits (OR=6.64 versus age ≤50, P=.002), mammography (OR=4.18, P=.020), or ET (OR=5.42, P=.002). Patients with performance status ECOG ≥2 had significantly lower adherence to all measures. Medicaid insurance was associated with significantly higher LTFU, non-adherence to mammography (OR=5.58, P=.008) or oncology visits (OR=6.53, P=.002). Marital, employment, or parenting status were not significantly associated with the risk of LTFU, but employed patients had a higher adherence to mammography and ET. Cancer stage, ER, or HER2 status were not associated with any adherence measure. LTFU was lower among recipients of ET, but not recipients of chemotherapy. In a multivariable model, Medicaid insurance (OR=3.99, P=.027) and receipt of ET (OR=0.32, P=.027) retained significant association with LTFU. Our findings show that Medicaid patients represent a high risk group with potential need for increased resources to ensure adequate follow-up. We plan to continue to expand this cohort and analyze more patients at our institution. Interventions to change barriers and circumvent financial limitations that these patients face in obtaining care could potentially decrease rates of recurrence and potentially impact overall survival. This data could be utilized in future studies to create a risk stratification tool to identify patients who would be at high risk for LTFU. Table. Factors associated with loss to follow-up.N (%)% LTFU at 5yOR95%CIPAll13917Age ≤5032 (23)161.00351-7070 (50.4)120.890.27-2.90&amp;gt;7037 (26.6)223.511.19-10.4ECOG 015 (10.8)71.0071108 (77.7)153.650.43-31.1&amp;gt; 214 (10.1)2920.281.90-216Insurance: private78 (56.1)91.001Medicaid15 (10.8)466.762.03-22.5Medicare45 (32.4)195.131.98-13.3Children: no70 (50.4)121.34yes66 (47.5)191.710.56-5.22Married: no56 (40.3)171.68yes83 (59.7)160.840.38-1.88Employed: no70 (50.4)201.32yes66 (47.5)150.660.29-1.49Stage:187 (62.6)181.66239 (28.1)120.640.24-1.69313 (9.4)220.80.19-3.46ER-23 (16.5)261.27ER+115 (82.7)150.580.22-1.54No ET38 (27.3)291.033ET101 (72.7)120.410.18-0.93No chemotherapy87 (62.6)171.25Chemotherapy52 (37.4)160.60.25-1.43 Citation Format: Rani Chudasama, Adam Olszewski, Don Dizon, Mary Anne Fenton. Patient risk factors for loss to breast oncologic follow up [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-57.