Management of Non-Proliferative Breast Changes
Clinical Follow-Up Schedule
- The American Society of Clinical Oncology recommends history and physical examination every 3-6 months for the first 3 years, every 6-12 months for years 4 and 5, and annually thereafter for patients with non-proliferative breast changes 1, 2
- The examination should be conducted by a physician experienced in breast examination and cancer surveillance, with follow-up schedules of every 3-6 months for the first 3 years, every 6-12 months for years 4 and 5, and annually thereafter 1, 2, 3
Mammographic Surveillance
- The National Comprehensive Cancer Network recommends annual mammography for routine surveillance, with the first post-treatment mammogram 1 year after initial mammogram but no earlier than 6 months after completing radiation therapy for patients who underwent breast-conserving surgery 1, 2
- Bilateral mammography is recommended to monitor both the affected and contralateral breast 4, 5
Patient Education
- The American Cancer Society recommends counseling patients to report new breast lumps, bone pain, chest pain or dyspnea, abdominal pain, and persistent headaches immediately 1, 3
- All women should be instructed to perform monthly breast self-examination 1, 3
Genetic Counseling Considerations
- The American Society of Clinical Oncology recommends referring patients for genetic counseling if they have Ashkenazi Jewish heritage, personal or family history of ovarian cancer, first-degree relative with breast cancer diagnosed before age 50, or two or more first- or second-degree relatives with breast cancer at any age 1, 3
What NOT to Do
- The American College of Radiology recommends against routine surveillance with complete blood counts, automated chemistry panels, chest x-rays, bone scans, liver ultrasounds, CT scans, PET scans, breast MRI, and tumor markers (CA 15-3, CA 27.29, CEA) in asymptomatic patients with non-proliferative changes 2, 3