Most locoregional recurrences occur within 5 years after diagnosis [34,35,44], with recurrence risk greatest 2 to 3 years after initial therapy [23,28,33,37]. Imaging after Breast Surgery There is suboptimal compliance of annual screening mammography in select patients with a history of breast cancer. Groups most impacted are younger women <45 to 50 years of age, older women >65 years of age, African Americans and other underrepresented minorities, and women who did not have a recent physician visit [34,45-50]. The ASTRO and NCCN guidelines both recommend annual mammographic surveillance for women who have completed radiation therapy as part of breast conservation therapy, with the first imaging performed at 6 to 12 months [51,52]. Other studies have found imaging before 12 months is not beneficial and/or leads to unnecessary additional imaging due to acute breast changes, supporting the first mammogram to be at 12 months after the last mammogram [30,53-56]. More frequent imaging of the ipsilateral affected breast beyond annual surveillance mammography, at 6-month intervals for the first 2 to 5 years, has also been studied. Two groups showed no benefits to this more frequent imaging [30,56]. One study found lower stage of recurrence in women undergoing 6-month surveillance compared with annual surveillance; however, this may be secondary to decreased compliance with imaging recommendations in the annual surveillance group and follow-up was insufficient to assess for any mortality differences [57]. The addition of DBT to 2-D digital mammography or 2-D synthetic images in the surveillance of patients with prior breast cancer history, has been shown to reduce recall rates and indeterminate findings [58-61], without significant change in cancer detection rate [60,61]. MRI Breast Without and With IV Contrast There is insufficient literature to support the routine use of MRI breast without and with IV contrast in this clinical scenario.
Imaging after Breast Surgery. Most locoregional recurrences occur within 5 years after diagnosis [34,35,44], with recurrence risk greatest 2 to 3 years after initial therapy [23,28,33,37]. Imaging after Breast Surgery There is suboptimal compliance of annual screening mammography in select patients with a history of breast cancer. Groups most impacted are younger women <45 to 50 years of age, older women >65 years of age, African Americans and other underrepresented minorities, and women who did not have a recent physician visit [34,45-50]. The ASTRO and NCCN guidelines both recommend annual mammographic surveillance for women who have completed radiation therapy as part of breast conservation therapy, with the first imaging performed at 6 to 12 months [51,52]. Other studies have found imaging before 12 months is not beneficial and/or leads to unnecessary additional imaging due to acute breast changes, supporting the first mammogram to be at 12 months after the last mammogram [30,53-56]. More frequent imaging of the ipsilateral affected breast beyond annual surveillance mammography, at 6-month intervals for the first 2 to 5 years, has also been studied. Two groups showed no benefits to this more frequent imaging [30,56]. One study found lower stage of recurrence in women undergoing 6-month surveillance compared with annual surveillance; however, this may be secondary to decreased compliance with imaging recommendations in the annual surveillance group and follow-up was insufficient to assess for any mortality differences [57]. The addition of DBT to 2-D digital mammography or 2-D synthetic images in the surveillance of patients with prior breast cancer history, has been shown to reduce recall rates and indeterminate findings [58-61], without significant change in cancer detection rate [60,61]. MRI Breast Without and With IV Contrast There is insufficient literature to support the routine use of MRI breast without and with IV contrast in this clinical scenario.