More recent studies indicate the risk of developing locoregional recurrence in patients with early stage disease treated with breast-conserving surgery, whole-breast radiation, and appropriate systemic treatments is approximately 0.5% per year [169]. In 1 meta-analysis, the 10-year local recurrence rate in patients after neoadjuvant chemotherapy and breast conservation was 6.5% and locoregional disease recurrence was 10.3%. Factors found to be associated with a higher risk of local recurrence were ER-negative disease, axillary spread, especially in >3 nodes or clinically palpable disease, and a lack of pathologic complete response [170]. Studies have shown that early detection of recurrence (prior to clinical detection) improves long-term survival by approximately 17% to 28% [171]. Therefore, imaging surveillance remains important in this patient population. Digital Breast Tomosynthesis Diagnostic 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. 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. More recent studies indicate the risk of developing locoregional recurrence in patients with early stage disease treated with breast-conserving surgery, whole-breast radiation, and appropriate systemic treatments is approximately 0.5% per year [169]. In 1 meta-analysis, the 10-year local recurrence rate in patients after neoadjuvant chemotherapy and breast conservation was 6.5% and locoregional disease recurrence was 10.3%. Factors found to be associated with a higher risk of local recurrence were ER-negative disease, axillary spread, especially in >3 nodes or clinically palpable disease, and a lack of pathologic complete response [170]. Studies have shown that early detection of recurrence (prior to clinical detection) improves long-term survival by approximately 17% to 28% [171]. Therefore, imaging surveillance remains important in this patient population. Digital Breast Tomosynthesis Diagnostic 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. 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.