Non Adherence to Post Surgery Annual Surveilance Mammogram and Follow Up Among Breast Cancer Survivors in a Tertiary Care Hospital in Malaysia

PURPOSE The importance of surveillance mammogram and follow up post breast cancer surgery has been emphasised in most international and local guidelines including Malaysian Clinical Practice Guidelines (CPG). There is insufficient real-world data in Malaysia to assess the adherence to CPG guideline. This study aimed to determine the adherence rate and identify factors affecting patients adherence. Association between adherence to surveillance mammogram and follow up with survival rate is studied. METHODS 776 women with newly diagnosed stage 1 to 3 breast cancer in Sarawak General Hospital between January 2010 and December 2018 post breast cancer surgery were included in this study. Sociodemographic, clinical, tumour and treatment characteristics and follow up details were collected from clinic records. Factors associated with compliance to mammogram in the first three years were analysed using logistic regression. RESULTS The adherence to surveillance mammogram declined gradually from 84.9% at the 1st year, 78.1% at the 5th year and 38.1 at the 10th year. Non adherence to surveillance mammogram in the first 3 years post surgery was significantly associated with 4 independent factors: Charlson Co-Morbidity Index Score (CCI) of >2, [odd ratio (OR) 3.34, 95% confidence interval (CI) 1.17-9.52 for CCI >2 versus CCI of 0];disease staging [OR 2.18, 95% CI 1.12-4.22 for stage 3 breast cancer, and OR 2.00, CI 1.04-3.18 for stage 2b breast cancer versus stage 1 breast cancer];chemotherapy [OR 1.89, 95% confidence interval (CI) 1.09-3.25 for patients who do not have chemotherapy versus reference group] and completion of recommended adjuvant therapy [OR 2.70, 95% confidence interval (CI) 1.03-7.11 for patient who do not complete recommended adjuvant therapy versus reference group]. Non-adherent to the first three-year surveillance mammogram is associated with a poorer 5-year overall survival rate. CONCLUSION There is a decline in adherence rate to annual surveillance mammogram over time among breast cancer survivors. Future study on measures to improve adherence in these subgroups of patients is needed.