Patterns of Breast Imaging Use Among Women with a Personal History of Breast Cancer

  • Louise M. HendersonEmail author
  • Laura Ichikawa
  • Diana S. M. Buist
  • Janie M. Lee
  • Mary Bush
  • Dianne Johnson
  • Tracy Onega
  • Larissa Nekhlyudov
  • Karla Kerlikowske
  • Diana L. Miglioretti
  • Brian L. Sprague
  • Karen J. Wernli



National patterns of breast imaging in women with a personal history of breast cancer (PHBC) are unknown making evaluation of annual surveillance recommendations a challenge.


To describe variation in use of mammography and breast magnetic resonance imaging (MRI) examinations beginning 6 months after diagnosis among women with PHBC in US community practice. We report on the breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.


Longitudinal study using cross-sectional data.


Breast Cancer Surveillance Consortium breast imaging facilities.


19,955 women diagnosed between 2005 and 2012 with AJCC stage 0-III incident breast cancer who had 69,386 mammograms and 3,553 breast MRI examinations from January 2005 to September 2013; median follow-up of 37.6 months (interquartile range, 22.1–60.7).

Main Measures

Breast imaging indication, imaging intervals, and time since breast cancer diagnosis by examination type.

Key Results

Among women with a PHBC who received breast imaging, 89.4% underwent mammography alone, 0.8% MRI alone, and 10.3% had both mammography and MRI. About half of mammograms and MRIs were indicated for surveillance vs. diagnostic, with an increase in the proportion of surveillance exams as time from diagnosis increased (mammograms, 45.7% at 1 year to 72.2% after 5 years; MRIs, 54.8% at 1 year to 78.6% after 5 years). In the first post-diagnosis period, 32.8% of women had > 2 breast imaging examinations and of these, 65.8% were less than 6 months apart. During the first 5-year post-diagnosis, the frequency of examinations per year decreased and the interval between examinations shifted towards annual examinations.


In women with a PHBC who received post-diagnosis imaging, a third underwent multiple breast imaging examinations per year during the first 2-year post-diagnosis despite recommendations for annual exams. As time since diagnosis increases, imaging indication shifts from diagnostic to surveillance.


breast cancer cancer surveillance mammography breast magnetic resonance imaging cancer survivorship 



We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. Further, we thank the study Patient Advisory Board and Stakeholder Panel for their ongoing support of this research project.

Authors’ Contribution

The collection of cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the US. For a full description of the BCSC, please see:


This study was funded by the Patient-Centered Outcomes Research Institute (PCORI) (grant number CE-1304-6656 “Comparative effectiveness of surveillance imaging modalities in breast cancer survivors”) and the National Cancer Institute (grant numbers: P01 CA154292, U54 CA163303).

Compliance with Ethical Standards

Conflict of Interest

Author Diana L. Miglioretti was a member of the Scientific Advisory Board for Hologic in 2017. Author Janie M. Lee is a consultant for General Electric Healthcare and receives a Research Grant from General Electric Healthcare. All remaining authors declare that they do not have a conflict of interest.


The design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication are solely the responsibility of the authors and does not necessarily represent the official views of the Patient-Centered Outcomes Research Institute, the National Cancer Institute or the National Institutes of Health.

Supplementary material

11606_2019_5181_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 25 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Louise M. Henderson
    • 1
    Email author
  • Laura Ichikawa
    • 2
  • Diana S. M. Buist
    • 2
  • Janie M. Lee
    • 3
  • Mary Bush
    • 2
  • Dianne Johnson
    • 2
  • Tracy Onega
    • 4
  • Larissa Nekhlyudov
    • 5
  • Karla Kerlikowske
    • 6
    • 7
  • Diana L. Miglioretti
    • 2
    • 8
  • Brian L. Sprague
    • 9
  • Karen J. Wernli
    • 2
  1. 1.Department of Radiology The University of North Carolina Chapel Hill NCChapel HillUSA
  2. 2.Kaiser Permanente Washington Health Research InstituteSeattleUSA
  3. 3.Department of Radiology, Seattle Cancer Care AllianceUniversity of WashingtonSeattleUSA
  4. 4.Department of Biomedical Data ScienceGeisel School of Medicine at DartmouthLebanonUSA
  5. 5.Department of MedicineBrigham and Women’s HospitalBostonUSA
  6. 6.Department of Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  7. 7.Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  8. 8.Department of Public Health Sciences, School of MedicineUniversity of California, DavisDavisUSA
  9. 9.Department of SurgeryUniversity of Vermont College of MedicineBurlingtonUSA

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