Screening chest imaging studies are not effective in the follow-up of breast cancer patients

To determine the utility of chest imaging after adjuvant therapy for breast cancer in detection of recurrent disease.

This is a retrospective review of 786 patients diagnosed with early stage breast cancer between 1996-1998 at Memorial Sloan Kettering Cancer Center. 250 of these patients had a chest radiograph or CT scan performed greater that one year after their original diagnosis. Patients were stratified as to whether the chest imaging study was ordered for screening or to evaluate symptoms.

533 chest imaging studies were performed: 397 (74%) chest radiographs and 136 (26%) CT scans. Ten (4%) patients developed metastatic breast cancer. Two patients (0.8%) were found to have metastatic disease by chest radiographs: one (0.4%) was symptomatic and one was not. The remaining eight patients had a negative chest x-ray within one year. No patients were found to have metastatic disease by chest CT. A 2nd primary cancer was found in three patients (1.2%) all of whom had a negative chest x-ray in the past year. There were 20 abnormal radiology studies: 2 true positive (2/20 = 10%) and 18 false positive (18/20 = 90%).

Within this duration of follow-up, we conclude that chest imaging is of limited value for asymptomatic patients with a history of breast cancer and has a high false positive rate.