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]. Digital Breast Tomosynthesis Screening Annual mammography is the best imaging test for surveillance in this clinical scenario, with reduction of mortality compared with women with history of breast cancer who do not get annual mammography [40,41]. The most common presentation of a recurrent or second breast cancer in patients with a personal history of breast cancer is an abnormal mammogram in an otherwise asymptomatic patient [22,34,36]. The ACR practice parameters state asymptomatic women previously treated for breast cancer may undergo annual screening or diagnostic mammography, as determined by the imaging facility [42]. The most common factor influencing this decision is the number of years since cancer diagnosis and treatment. A survey of radiologists showed variability in recommendation of diagnostic versus screening mammography for women treated with breast conservation therapy. Most (79%) recommended at least 1 diagnostic mammogram, with 49% recommending diagnostic mammography up to 2 years and 33% recommending diagnostic mammography from 2 to 5 years [43].
Imaging after Breast Surgery. 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]. Digital Breast Tomosynthesis Screening Annual mammography is the best imaging test for surveillance in this clinical scenario, with reduction of mortality compared with women with history of breast cancer who do not get annual mammography [40,41]. The most common presentation of a recurrent or second breast cancer in patients with a personal history of breast cancer is an abnormal mammogram in an otherwise asymptomatic patient [22,34,36]. The ACR practice parameters state asymptomatic women previously treated for breast cancer may undergo annual screening or diagnostic mammography, as determined by the imaging facility [42]. The most common factor influencing this decision is the number of years since cancer diagnosis and treatment. A survey of radiologists showed variability in recommendation of diagnostic versus screening mammography for women treated with breast conservation therapy. Most (79%) recommended at least 1 diagnostic mammogram, with 49% recommending diagnostic mammography up to 2 years and 33% recommending diagnostic mammography from 2 to 5 years [43].