Skip to main content

Advertisement

Log in

Posttreatment Breast Imaging Considerations

  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Surveillance imaging improves survival in women with a personal history of breast cancer (PHBC); however, imaging strategies vary in this population. This review evaluated current literature and guidelines regarding imaging modalities and approaches in women with PHBC.

Recent Findings

The consensus among major breast societies is that annual surveillance mammography is recommended in all women with PHBC. Noting limitations of mammography, supplemental imaging modalities have emerged and are increasingly utilized by practices, providing the benefit of incremental cancer detection at the expense of potential additional false-positive workups.

Summary

Annual surveillance mammography is associated with improved outcomes among women with PHBC. Accurate risk assessment and careful patient selection are needed when considering supplemental imaging, in order to maximize benefits, limit false-positive workups, and appropriately utilize limited resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Not applicable.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Lawson MB, Herschorn SD, Sprague BL, Buist DSM, Lee S-J, Newell MS, et al. Imaging surveillance options for individuals with a personal history of breast cancer: AJR expert panel narrative review. AJR Am J Roentgenol. 2022;219(6):854–68. https://doi.org/10.2214/AJR.22.27635. This thorough review of imaging in women with prior breast cancers provides a risk-based stratification approach that could be utilized to improve shared decision-making when selecting a supplemental imaging modality.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lee JM, Buist DSM, Houssami N, Dowling EC, Halpern EF, Gazelle GS, et al. Five-year risk for interval-invasive second breast cancer. J Natl Cancer Inst. 2015;107(7):109. https://doi.org/10.1093/jnci/djv109.

    Article  CAS  Google Scholar 

  3. Buist DSM, Abraham LA, Barlow WE, Krishnaraj A, Holdridge RC, Sickles EA, et al. Diagnosis of second breast cancer events after initial diagnosis of early stage breast cancer. Breast Cancer Res Treat. 2010;124(3):863–73. https://doi.org/10.1007/s10549-010-1106-6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lam DL, Houssami N, Lee JM. Imaging surveillance after primary breast cancer treatment. AJR Am J Roentgenol. 2017;208(3):676–86. https://doi.org/10.2214/AJR.16.16300.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gunia SR, Merrigan TL, Poulton TB, Mamounas EP. Evaluation of appropriate short-term mammographic surveillance in patients who undergo breast-conserving surgery (BCS). Ann Surg Oncol. 2012;19(10):3139–43. https://doi.org/10.1245/s10434-012-2578-x.

    Article  PubMed  Google Scholar 

  6. Kokko R, Hakama M, Holli K. Follow-up cost of breast cancer patients with localized disease after primary treatment: a randomized trial. Breast Cancer Res Treat. 2005;93(3):255–60. https://doi.org/10.1007/s10549-005-5199-2.

    Article  CAS  PubMed  Google Scholar 

  7. Gradishar WJ, Moran MS, Abraham J, Abramson V, Aft R, Agnese D, et al. NCCN guidelines: breast cancer, version 4.2023. Natl Compr Cancer Net. 2023;21(6):594–608.

    Article  Google Scholar 

  8. Mehta TS, Lourenco AP, Niell BL, Bennett DL, Brown A, Chetlen A, et al. ACR appropriateness criteria: imaging after breast surgery. J Am Coll Radiol. 2022;19(11S):S341–56. https://doi.org/10.1016/j.jacr.2022.09.003.

    Article  PubMed  Google Scholar 

  9. Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. CA Cancer J Clin. 2016;34(6):611–35. https://doi.org/10.3322/caac.21319.

    Article  CAS  Google Scholar 

  10. The American Society of Breast Surgeons: position statement on screening mammography. Available at https://www.breastsurgeons.org/docs/statements/Position-Statement-on-Screening-Mammography.pdf. Accessed on 7 Mar 2023.

  11. Mammograms After Breast Cancer Surgery. Available at https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/having-a-mammogram-after-youve-had-breast-cancer-surgery.html. Accessed on 7 Mar 2023.

  12. Bahl M, Mercaldo S, McCarthy AM, Lehman CD. Imaging surveillance of breast cancer survivors with digital mammography versus digital breast tomosynthesis. Radiology. 2021;298(2):308–16. https://doi.org/10.1148/radiol.2020201854.

    Article  PubMed  Google Scholar 

  13. Osman NM, Ghany EA, Chalabi N. The added benefit of digital breast tomosynthesis in second breast cancer detection among treated breast cancer patients. Egypt J Radiol Nucl Med. 2018;49(4):1182–6. https://doi.org/10.1016/j.ejrnm.2018.07.007.

    Article  Google Scholar 

  14. • Yoon JH, Kim EK, Kim GR, Han K, Moon HJ. Mammographic surveillance after breast-conserving therapy: impact of digital breast tomosynthesis and artificial intelligence–based computer-aided detection. AJR Am J Roentgenol. 2022;218(1):42–51. https://doi.org/10.2214/AJR.21.26506. This study evaluated the role of AI in postoperative mammograms and found that it led to improved accuracy and reduced recall rates compared to digital mammography alone.

    Article  PubMed  Google Scholar 

  15. Patel BK, Lee CS, Kosiorek HE, Newell MS, Pizzitola VJ, D’Orsi CJ. Variability of postsurgical imaging surveillance of breast cancer patients: a nationwide survey study. AJR Am J Roentgenol. 2018;210(1):222–7. https://doi.org/10.2214/AJR.17.17923.

    Article  PubMed  Google Scholar 

  16. Nguyen DL, Liang A, Mullen LA, Oluyemi E, Myers KS, Panigrahi B, et al. Diagnostic versus screening mammography recommendations for postlumpectomy imaging surveillance of patients with breast cancer. AJR Am J Roentgenol. 2021;217(5):1081–2. https://doi.org/10.2214/AJR.20.25417.

    Article  PubMed  Google Scholar 

  17. Bychkovsky BL, Lin NU. Imaging in the evaluation and follow-up of early and advanced breast cancer: when, why, and how often? Breast. 2017;31:318–24. https://doi.org/10.1016/j.breast.2016.06.017.

    Article  PubMed  Google Scholar 

  18. Smith D, Sepehr S, Karakatsanis A, Strand F, Valachis A. Yield of surveillance imaging after mastectomy with or without reconstruction for patients with prior breast cancer: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(12):e2244212. https://doi.org/10.1001/jamanetworkopen.2022.44212.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Freyvogel M, Padia S, Larson K, Dietz J, Grobmyer S, O’Rourke C, et al. Screening mammography following autologous breast reconstruction: an unnecessary effort. Ann Surg Oncol. 2014;21(10):3256–60. https://doi.org/10.1245/s10434-014-3913-1.

    Article  PubMed  Google Scholar 

  20. Noroozian M, Carlson LW, Savage JL, Jeffries DO, Joe AI, Neal CH, et al. Use of screening mammography to detect occult malignancy in autologous breast reconstructions: a 15-year experience. Radiology. 2018;289(1):39–48. https://doi.org/10.1148/radiol.2018172783.

    Article  PubMed  Google Scholar 

  21. Gradishar WJ, Moran MS, Abraham J, Abramson V, Aft R, Agnese D, et al. NCCN guidelines: breast cancer, version 4.2023. National Comprehensive Cancer Network. 2023:226.

  22. Heller SL, Lourenco AP, Niell BL, Ajkay N, Brown A, Dibble EH, et al. ACR appropriateness criteria: imaging after mastectomy and breast reconstruction. J Am Coll Radiol. 2020;17(11S):S403–14. https://doi.org/10.1016/j.jacr.2020.09.009.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee JM, Ichikawa LE, Wernli KJ, Bowles E, Specht JM, Kerlikowske K, et al. Digital mammography and breast tomosynthesis performance in women with a personal history of breast cancer, 2007–2016. Radiology. 2021;300(2):290–300. https://doi.org/10.1148/radiol.2021204581.

    Article  PubMed  Google Scholar 

  24. Gweon HM, Cho N, Han W, Yi A, Moon HG, Noh DY, et al. Breast MR imaging screening in women with a history of breast conservation therapy. Radiology. 2014;272(2):366–73. https://doi.org/10.1148/radiol.14131893.

    Article  PubMed  Google Scholar 

  25. Cho N, Han W, Han BK, Bae MS, Ko ES, Nam SJ, et al. Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years or younger at diagnosis and treated with breast conservation therapy. JAMA Oncol. 2017;3(11):1495–502. https://doi.org/10.1001/jamaoncol.2017.1256.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wernli KJ, Ichikawa L, Kerlikowske K, Buist DSM, Brandzel SD, Bush M, et al. Surveillance breast MRI and mammography: comparison in women with a personal history of breast cancer. Radiology. 2019;292(2):311–8. https://doi.org/10.1148/radiol.2019182475.

    Article  PubMed  Google Scholar 

  27. Buist DSM, Abraham L, Lee CI, Lee JM, Lehman C, O’Meara ES, et al. Breast biopsy intensity and findings following breast cancer screening in women with and without a personal history of breast cancer. JAMA Intern Med. 2018;178(4):458–68. https://doi.org/10.1001/jamainternmed.2017.8549.

    Article  PubMed  PubMed Central  Google Scholar 

  28. •• Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 2018;15(3):408–14. https://doi.org/10.1016/j.jacr.2017.11.034. This article summarizes the imaging recommendations for women at higher-than-average risk of breast cancer, including the expansion of supplemental surveillance MRI to women with PHBC who have dense breasts or were diagnosed with breast cancer before age 50.

    Article  PubMed  Google Scholar 

  29. • Comstock CE, Gatsonis C, Newstead GM, Snyder BS, Gareen IF, Bergin JT, et al. Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening. JAMA. 2020;323(8):746–56. https://doi.org/10.1001/jama.2020.0572. This multi-center, cross-sectional longitudinal study evaluating screening in women with dense breasts found that abbreviated MRI was associated with a significantly higher detection of invasive breast cancer compared to DBT.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Park KW, Han SB, Han BK, Ko ES, Choi JS, Rhee SJ, et al. MRI surveillance for women with a personal history of breast cancer: comparison between abbreviated and full diagnostic protocol. Br J Radiol. 2020;93(1106):20190733. https://doi.org/10.1259/bjr.20190733.

    Article  PubMed  PubMed Central  Google Scholar 

  31. • Kim SY, Cho N, Hong H, Lee Y, Yoen H, Kim YS, et al. Abbreviated screening MRI for women with a history of breast cancer: comparison with full-protocol breast MRI. Radiology. 2022;305(1):36–45. https://doi.org/10.1148/radiol.213310. This propensity score-matched, single-center, retrospective cohort study found that abbreviated MRI was associated with comparable sensitivity and superior specificity compared to full-protocol MRI.

    Article  PubMed  Google Scholar 

  32. Song SE, Cho N, Chang JM, Chu AJ, Yi A, Moon WK. Diagnostic performances of supplemental breast ultrasound screening in women with personal history of breast cancer. Acta Radiol. 2018;59(5):533–9. https://doi.org/10.1177/0284185117725779.

    Article  PubMed  Google Scholar 

  33. Kim SY, Cho N, Kim SY, Choi Y, Kim ES, Ha SM, et al. Supplemental breast US screening in women with a personal history of breast cancer: a matched cohort study. Radiology. 2020;295(1):54–63. https://doi.org/10.1148/radiol.2020191691.

    Article  PubMed  Google Scholar 

  34. Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012;307(13):1394–404. https://doi.org/10.1001/jama.2012.388.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Gluskin J, Rossi Saccarelli C, Avendano D, Marino MA, Bitencourt AGV, Pilewskie M, et al. Contrast-enhanced mammography for screening women after breast conserving surgery. Cancers. 2020;12(12):3495. https://doi.org/10.3390/cancers12123495.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sorin V, Yagil Y, Yosepovich A, Shalmon A, Gotlieb M, Neiman OH, et al. Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. AJR Am J Roentgenol. 2018;211(5):W267–74. https://doi.org/10.2214/AJR.17.19355.

    Article  PubMed  Google Scholar 

  37. Jochelson MS, Lobbes MBI. Contrast-enhanced mammography: state of the art. Radiology. 2021;299(1):36–48. https://doi.org/10.1148/radiol.2021201948.

    Article  PubMed  Google Scholar 

  38. Rhodes DJ, Hruska CB, Conners AL, Tortorelli CL, Maxwell RW, Jones KN, et al. Molecular breast imaging at reduced radiation dose for supplemental screening in mammographically dense breasts. AJR Am J Roentgenol. 2015;204(2):241–51. https://doi.org/10.2214/AJR.14.13357.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

A.T. drafted the original manuscript. S.M. edited and supplemented the original manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Santo Maimone.

Ethics declarations

Ethical Approval

Not applicable.

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tavana, A., Maimone, S. Posttreatment Breast Imaging Considerations. Curr Breast Cancer Rep 15, 337–344 (2023). https://doi.org/10.1007/s12609-023-00511-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-023-00511-4

Keywords

Navigation