Key issues in surveillance of secondary breast cancer

To enable early detection of secondary cancers, such as contralateral breast cancer (CBC) or ipsilateral breast tumor recurrence (IBTR) in patients who have undergone breast cancer (BC) surgery, we examined the diagnostic history and surveillance challenges of CBC and IBTR.

We analyzed the clinical data of 111 patients with CBC and 66 with IBTR, focusing on follow-up, screening, and patient awareness. We also examined the sensitivity of each diagnostic modality.

The interval between primary and secondary cancer exceeded 10 years in 48% of CBC cases and 44% of IBTR cases. After 10 years, the proportion of patients diagnosed through follow-up decreased, whereas diagnoses through screening and awareness increased significantly. Among the three diagnostic groups, more advanced cancers were observed in the awareness group. When comparing diagnostic sensitivity, subjective symptoms were reported at similar rates for CBC (43.2%) and IBTR (48.5%). However, mammography (MMG) was significantly lower in IBTR (36.2%) than in CBC (70.8%) (p = 0.00), and ultrasound sonography (US) was lower in IBTR (84.8%) than in CBC (95.4%) (p = 0.02).

During postoperative surveillance, MMG sensitivity in the preserved breast was limited, thus suggesting the essence of careful US examination. More advanced cancer in the awareness group suggested long-term surveillance beyond 10 years is crucial, with a focus on promoting breast awareness and appropriate screening program for individual patient after hospital follow-up.