Imaging of Invasive Breast Cancer 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 annual follow-up. A single-institution study of 2,329 women following BCT showed that a 6-month interval for surveillance detected a higher proportion of local recurrences at an earlier stage compared with annual surveillance [174]. In a single-institution study of 789 asymptomatic women after BCT, 1.2% had cancer diagnosed at the 6-month timepoint following treatment (n = 169), and 0.6% had cancer detected in women who underwent routine mammographic screening a year after treatment (n = 620) [175]. However, earlier diagnosis did not result in a difference in local and distant disease-free survival. In summary, there is insufficient evidence demonstrating superior outcomes with diagnostic versus screening mammography for breast cancer surveillance. Expert consensus is to perform an annual diagnostic examination for the first 3 years, followed by routine annual screening, due to the increased complexity of interpretation from postsurgical and postradiation changes [176] and the increased risk of recurrence in the first 3 years following treatment [177-180]. There is evidence that mammography alone may not be sufficient for surveillance in this population.
Imaging of Invasive Breast Cancer. Imaging of Invasive Breast Cancer 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 annual follow-up. A single-institution study of 2,329 women following BCT showed that a 6-month interval for surveillance detected a higher proportion of local recurrences at an earlier stage compared with annual surveillance [174]. In a single-institution study of 789 asymptomatic women after BCT, 1.2% had cancer diagnosed at the 6-month timepoint following treatment (n = 169), and 0.6% had cancer detected in women who underwent routine mammographic screening a year after treatment (n = 620) [175]. However, earlier diagnosis did not result in a difference in local and distant disease-free survival. In summary, there is insufficient evidence demonstrating superior outcomes with diagnostic versus screening mammography for breast cancer surveillance. Expert consensus is to perform an annual diagnostic examination for the first 3 years, followed by routine annual screening, due to the increased complexity of interpretation from postsurgical and postradiation changes [176] and the increased risk of recurrence in the first 3 years following treatment [177-180]. There is evidence that mammography alone may not be sufficient for surveillance in this population.