Evaluating breast cancer screening concordance in survivorship care.

Abstract

647 Background: Adherence to guideline-based breast cancer screening in cancer survivors remains variable, representing a significant quality gap in survivorship care delivery. At MD Anderson Cancer Center, cancer survivors are transitioned to a specialized survivorship clinic once they reach remission and pass the period of highest risk for recurrence, as determined by evidence-based algorithms. This care model shifts the focus from illness to wellness and emphasizes surveillance, prevention, risk reduction, management of late effects, and psychosocial support. Care is delivered by advanced practice providers with specialized survivorship training. This study evaluates differences in guideline-concordant breast cancer screening between survivors who received a survivorship consult and those who continued care in primary oncology clinics as part of a quality improvement initiative. Methods: We conducted a retrospective observational analysis of 140 patients (280 visits) selected from Thyroid, Melanoma, Thoracic, and Head and Neck Cancer Survivorship Clinics. Patients were categorized into two groups: Arm 1 included survivors who completed two visits in a survivorship clinic during the study period (n=83), and Arm 2 included those managed exclusively in primary oncology clinics (n=114). Outcomes included screening eligibility, clinical breast exam documentation, mammogram recommendation, and concordance with a predefined screening algorithm. Algorithm concordance was defined as adherence to age-based recommendations for average-risk patients in the MD Anderson breast cancer screening algorithm. Comparisons between groups were performed using chi-square testing. Results: Overall, 70% of patients met criteria for recommended breast cancer screening. Attending a survivorship clinic appointment was associated with significantly improved adherence to guideline-based screening. Algorithm concordance was higher in Arm 1 compared to Arm 2 (79% vs 21%, p < 0.001). Survivors with a survivorship clinic appointment were more likely to have mammogram recommendations documented (92% vs 27%, p < 0.001) and clinical breast exams documented (44% vs 23%, p = 0.003). Differences in eligibility classification were also observed (p = 0.0006). Conclusions: This study identifies substantial quality gaps in breast cancer screening among survivors managed in primary oncology clinics. Integration of a structured survivorship care model was associated with significant improvements in guideline concordance and preventive care delivery. These findings support survivorship-specific care as an effective and scalable quality improvement strategy to standardize care and enhance delivery of evidence-based screening in cancer survivorship populations.