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]. Mammography With IV Contrast A large study (n = 858) comparing the use of mammography with IV contrast to 2-D mammography showed an increase in the sensitivity of cancer detection from 50% to 87.5% with minimal changes to the specificity (97.1% versus 93.7%, respectively) and PPV (25.0% versus 20.9%, respectively) [185]. This study cohort included a large portion of women with a personal history of breast cancer (40.2%) and women with dense breasts (77.5%), although no information is given about the time since breast cancer diagnosis or stage at presentation in the surveillance population. Imaging of Invasive Breast Cancer MRI Breast Without and With IV Contrast For most breast cancer survivors, there is insufficient evidence for or against the use of breast MRI to detect disease recurrence in women of average risk.
Imaging of Invasive Breast Cancer. 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]. Mammography With IV Contrast A large study (n = 858) comparing the use of mammography with IV contrast to 2-D mammography showed an increase in the sensitivity of cancer detection from 50% to 87.5% with minimal changes to the specificity (97.1% versus 93.7%, respectively) and PPV (25.0% versus 20.9%, respectively) [185]. This study cohort included a large portion of women with a personal history of breast cancer (40.2%) and women with dense breasts (77.5%), although no information is given about the time since breast cancer diagnosis or stage at presentation in the surveillance population. Imaging of Invasive Breast Cancer MRI Breast Without and With IV Contrast For most breast cancer survivors, there is insufficient evidence for or against the use of breast MRI to detect disease recurrence in women of average risk.