Annual Surveillance after Breast Cancer Treatment Overview
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So the next type of patient that we
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may see on a diagnostic breast imaging
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day is a patient who's having annual
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surveillance after breast cancer treatment.
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And there is an appropriateness criteria for
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these patients as well, so surveillance for
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local recurrence and distant metastases in
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asymptomatic women, sort of a long title.
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The ACR recommends annual mammography,
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and it can either be 2D or tomosynthesis.
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And interestingly, screening and diagnostic
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are given the same appropriateness category.
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At Hopkins, we do annual diagnostic
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mammography for three years and
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then return to screening thereafter.
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But we recognize that there's a
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range of practice patterns out there.
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So some practices will return to
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screening immediately after cancer
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treatment so that the next exam that
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the patient has is a screening exam.
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Others will do some variation on diagnostic
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mammography for on the order of two to
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five years and then return to screening.
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Others will treat the patient as
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diagnostic for the rest of their lives.
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There's really kind of a wide range and
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not a whole lot of evidence to support
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the timing of returning to screening.
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So, um, our group at Hopkins looked at
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this question to try to inform ourselves
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about this issue and, uh, when at all.
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retrospectively reviewed, um, the records of
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707 women who were treated for breast cancer and
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recommended for annual diagnostic mammography.
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So we do three years of diagnostic mammography.
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So what we were looking for was what
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happened to those people when they came
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back at the diagnostic mammography visit?
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You know, did they need additional
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views to get to the point of decision
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making beyond the CC and MLO views?
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So at one year, we found that
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18.8% required additional views.
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At two years, 11 percent required
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additional views, and at three years,
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9.9% required additional views.
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The rates of additional views at the two
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and three-year mark were similar to the
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institutional recall rate of about 10.1%.
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And the conclusion was that diagnostic
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mammography follow-up may be useful at
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the one-year mark, because that's a place
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where we might have extra additional views
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required, followed by a return to screening.
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And that was published in AJR in 2021.
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I have to say that we have continued to
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keep our recommendation at three years
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based on, you know, no particular evidence.
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But the one publication that does address
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this issue, um, suggests that maybe we
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could return to screening after one year.
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So, um, you know, what are we looking
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for when these patients come back?
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Well, it's the same thing that we're looking for
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on every mammogram exam that we do, including
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patients who are having routine screening:
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Um, masses, asymmetries, distortions,
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calcifications, and enlarged axillary
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lymph nodes, the same things.
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The confounder here is that a patient
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who has had a lumpectomy will have
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distortion at the lumpectomy site, maybe
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surgical clips, dystrophic calcifications.
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They may have developing or evolving
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fat necrosis with calcifications.
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Um, so, um, their breasts may change over
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a period of time and sometimes those changes
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can be concerning for recurrence or maybe
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obscure an area where recurrence is forming.
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So these are the important things to look for.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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