In a large study involving 32,331 women with a history of breast cancer undergoing 117,971 surveillance mammographic examinations (112,269 digital mammographic examinations and 5,702 DBT examinations), surveillance mammography performance in the detection of interval cancers was inferior to established screening mammography benchmarks [182], with the main limitation of this study being the relative low proportion of DBT examinations because DBT does detect more cancer than DM alone [183]. Women <50 years of age at primary breast cancer diagnosis appear to be at highest risk of a missed interval cancer using surveillance mammography [184]. These data suggest a need for evolving evidence-based surveillance recommendations on supplemental screening. Mammography Screening The most widely accepted guidelines regarding the surveillance of asymptomatic women with a history of breast cancer come from 2 national organizations: ASCO and NCCN [172,173]. Both organizations state that routine surveillance with an annual mammogram can detect an in-breast recurrence or a new primary breast cancer in women with an average risk for recurrence. However, there is institutional variation on the frequency (every 6 months versus annual) and time period (1-5 years post-BCT) for surveillance after BCT. There is also variation on whether to include women in the screening versus diagnostic patient populations, in which women in the diagnostic population wait for possible additional imaging needed to reach a final assessment prior to leaving the imaging facility, whereas women in the screening population could leave after their standard views are performed. The sensitivity of mammography is decreased due to post- treatment changes from surgery and radiation therapy, and some institutions prefer closer follow-up after BCT to assess changes due to radiation and surgery and potentially detect local recurrences earlier than on annual follow- up imaging.
Imaging of Invasive Breast Cancer. In a large study involving 32,331 women with a history of breast cancer undergoing 117,971 surveillance mammographic examinations (112,269 digital mammographic examinations and 5,702 DBT examinations), surveillance mammography performance in the detection of interval cancers was inferior to established screening mammography benchmarks [182], with the main limitation of this study being the relative low proportion of DBT examinations because DBT does detect more cancer than DM alone [183]. Women <50 years of age at primary breast cancer diagnosis appear to be at highest risk of a missed interval cancer using surveillance mammography [184]. These data suggest a need for evolving evidence-based surveillance recommendations on supplemental screening. Mammography Screening The most widely accepted guidelines regarding the surveillance of asymptomatic women with a history of breast cancer come from 2 national organizations: ASCO and NCCN [172,173]. Both organizations state that routine surveillance with an annual mammogram can detect an in-breast recurrence or a new primary breast cancer in women with an average risk for recurrence. However, there is institutional variation on the frequency (every 6 months versus annual) and time period (1-5 years post-BCT) for surveillance after BCT. There is also variation on whether to include women in the screening versus diagnostic patient populations, in which women in the diagnostic population wait for possible additional imaging needed to reach a final assessment prior to leaving the imaging facility, whereas women in the screening population could leave after their standard views are performed. The sensitivity of mammography is decreased due to post- treatment changes from surgery and radiation therapy, and some institutions prefer closer follow-up after BCT to assess changes due to radiation and surgery and potentially detect local recurrences earlier than on annual follow- up imaging.