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Optimizing surveillance mammography following breast conservation surgery
S C Weight1, R Windle, A T Stotter
1St Marks Breast Centre, Glenfield Hospital, 10 St Marks Road, Remuera, Auckland, New Zealand. s.weight@smwh.co.nz
Summary
The 1-year mammogram after breast conservation surgery (BCT) may be safely omitted for most patients. Local recurrence (LR) risk is very low at 12 months, allowing for biennial screening in low-risk cases.
Area of Science:
- Oncology
- Radiology
- Surgical Oncology
Background:
- Early detection of local recurrence (LR) after breast conservation surgery (BCT) is crucial for survival.
- Current practice involves annual mammography starting 1 year post-surgery.
- Delayed radiotherapy due to chemotherapy can complicate early mammography, causing patient discomfort and reducing film quality.
Purpose of the Study:
- To evaluate the safety of omitting the 1-year surveillance mammogram following BCT.
- To determine the cumulative risk of local recurrence within the first 12 months post-surgery.
Main Methods:
- Retrospective review of 1151 patients undergoing BCT for in situ, stage I, or II breast cancer over 10 years.
- All patients had clear resection margins and received adjuvant treatments including radiotherapy, chemotherapy, and/or tamoxifen.
- Data on local recurrence rates at 12 and 24 months were analyzed.
Main Results:
- The overall 5-year actuarial rate of local recurrence was 4.8%.
- The cumulative risk of LR at 12 months was only 0.3% (3 patients).
- Higher risk patients (high-grade DCIS, NPI >6.0) were included in this low 12-month recurrence rate.
Conclusions:
- The cumulative risk of local recurrence at 12 months post-BCT is very low (0.3%), even in high-risk groups.
- Routine biennial mammography, starting after the initial post-operative period, is proposed.
- Exceptions are patients with high risk of early LR, such as extensive high-grade in situ disease.