Mammographic Surveillance for Patients with a History of Breast Cancer

Recommended Surveillance Protocol

The American College of Radiology recommends that women with a history of breast cancer should continue annual mammography screening as long as they remain in overall good health and have a life expectancy of at least 10 years, regardless of age 1, 2, 3
Annual mammography is the best imaging test for surveillance in patients with a history of breast cancer, with demonstrated reduction in mortality compared to those who do not undergo annual mammography 4, 5
The most common presentation of recurrent or second breast cancer in patients with a personal history of breast cancer is an abnormal mammogram in an otherwise asymptomatic patient 4, 6
Women with a personal history of breast cancer develop a second breast cancer at a rate of 5% to 10% within 5 to 10 years after initial diagnosis 4

There is no upper age limit agreed upon for screening mammography 1, 2
Screening recommendations should be based upon life expectancy and competing comorbidities, rather than age alone 1, 3
Women should continue screening mammography as long as they remain in overall good health and have a life expectancy of at least 10 years 1, 2

The American Society of Radiation Oncology (ASTRO) and National Comprehensive Cancer Network (NCCN) both recommend annual mammographic surveillance for women who have completed treatment for breast cancer 6, 7
For women treated with breast conservation therapy, the first post-treatment mammogram should be performed at 6 to 12 months after completion of radiation therapy 8, 7
Subsequent mammograms should be obtained annually for surveillance 4, 8

Factors that predict risk of locoregional recurrence include age, tumor grade and size, multifocality, nodal involvement, receptor status, and previous treatments 4
Most locoregional recurrences occur within 5 years after diagnosis, with recurrence risk greatest 2-3 years after initial therapy 6, 7

More than one-third of all breast cancer deaths each year are attributable to women diagnosed after age 70 2
For women with a personal history of breast cancer, the risk of recurrence or second primary cancer justifies continued surveillance 4, 5
Digital breast tomosynthesis (DBT) added to standard mammography has been shown to reduce recall rates and indeterminate findings in surveillance of patients with prior breast cancer history 6, 7