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Twice Yearly Mammograms?

Posted 8/10/2016

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A recent study, as reported here by BreastCancer.org, suggests that women should have twice yearly mammograms after lumpectomy. Since 10-20% of women who have had this surgery for early breast cancer will go on to develop a local recurrence or a second breast cancer, the finding is that more frequent tests will discover these cancers when they are smaller, less likely to have spread to the axillary lymph nodes, and, presumably, more curable.

Since this is not the traditional standard of care, you may want to talk about the possibility with your doctors

ARRS: Twice Yearly Mammograms Best After Lumpectomy

2010-05-13T04:54:07-04:00

Charles Bankhead

What breastcancer.org says about this article…

ARRS: Twice Yearly Mammograms Best After Lumpectomy

The study reviewed here suggests that having mammograms twice per year after lumpectomy finds a cancer recurrence (or a new cancer) earlier than only one mammogram per year after surgery.

A woman diagnosed with early-stage breast cancer who has lumpectomy to remove the cancer usually has radiation therapy after surgery. Her treatment plan also may include chemotherapy and hormonal therapy. These treatments are given after lumpectomy to lower the risk of the cancer coming back (recurrence). Still, breast cancer recurrence does happen.

Also, the risk of developing a new, second breast cancer in the same or opposite breast is much higher than average after being diagnosed with breast cancer. About 10% to 20% of women who have lumpectomy to remove early-stage breast cancer will have a recurrence of that cancer or develop a new, second breast cancer.

Doctors often recommend an aggressive screening plan after lumpectomy to make sure that any new or recurring breast cancer is found early, when it's most treatable. This might mean having mammograms more often than once per year, which is the recommendation for women 40 and older with average breast cancer risk.

In this study, researchers looked 10,750 mammograms done in 2,329 women who had lumpectomy to remove early-stage breast cancer between 1997 and 2008. After surgery, it was recommended that all the women have two screening mammograms per year. Five years after surgery, most mammograms were being done twice per year, but about 10% were being done only once per year.

The mammograms found 158 breast abnormalities and 114 of these (72%) were breast cancer. The researchers compared the characteristics of the breast cancers found by mammograms done twice per year to cancers found by mammograms done only once per year.

Cancers found by mammograms done twice per year were:

More likely to be stage 0 or stage 1:

94% of cancers found by twice-yearly mammograms were stage 0 or stage 1 compared to only 73% of cancers found by once-per-year mammograms. Generally, the lower the cancer's stage at diagnosis, the easier it is to treat and the better the prognosis.

Smaller in size:

Cancers found by twice-yearly mammograms were about 11.5 millimeters (mm) in size compared to an average of 15.3 mm for cancers found by once-per-year mammograms. Generally, the smaller the cancer at diagnosis, the easier it is to treat and the better the prognosis.

More likely not to have spread to nearby lymph nodes:

98% of cancers found by twice-yearly mammograms hadn't spread to nearby lymph nodes (called node-negative) compared to 91% of cancers found by once-per-year mammograms. Generally, node-negative breast cancers have a better prognosis than cancers that have spread to the lymph nodes.

These results suggest that cancers found by mammograms done twice per year after lumpectomy may have a better prognosis than cancers found by mammograms done once per year after lumpectomy. Still, the study only looked at the characteristics of the cancers at diagnosis, not the treatment outcomes. So we don't know if women who had two mammograms per year after lumpectomy had better survival compared to women who had only one mammogram per year after lumpectomy. More research, including looking at treatment outcomes, is needed before we know for sure that two mammograms per year after lumpectomy should be the standard.

If you've been diagnosed with early-stage breast cancer and are having lumpectomy, you and your doctor likely will develop a screening plan that's more aggressive than average to find any cancer recurrence or a new, second breast cancer. Your plan may include frequent exams by your doctor, breast self-exams, mammograms, or other imaging tests, such as MRI. The study reviewed here suggests that two mammograms per year after surgery may make sense. Sticking with your screening plan is just as important as making the plan. After your treatment is done, you may be tempted to skip some follow-up screening tests. Don't -- there's only one of you, and you and your future deserve the best care possible.

It's also important to do all you can to lower your risk of recurrence or a new, second breast cancer. Visit

the Breastcancer.org Lowering Risk for People with a Personal History page to learn more.

Research News on Screening and Testing

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SAN DIEGO (MedPage Today) -- Breast cancer patients who had recurrences after lumpectomy had less

advanced recurrent tumors if they adhered to a semiannual mammography schedule, data from a large

retrospective case review showed.

Semiannual screening was associated with an almost 30% increase in the proportion of recurrences detected

in stages 0 or 1 compared with annual follow-up, according to a presentation here at the American

Roentgen Ray Society meeting.

Additionally, recurrences detected by more frequent mammograms tended to be 25% smaller, according to

Vignesh Arasu, MD, of the University of California San Francisco, and colleagues. "Our results are not definitive proof that more frequent mammographic surveillance will improve outcomes, but they do suggest that these women may need to be treated differently from women in the general population who have average risk," Arasu said in an interview.

Between 10% and 20% of breast cancer patients have recurrences or new primary tumors in the ipsilateral breast after lumpectomy. Recurrent disease increases the risk of breast cancer mortality by as much as 300% compared with the initial tumor, said Arasu.

The optimal frequency of mammographic follow-up after lumpectomy has not been determined, although many patients have annual mammography.

"Most national organizations recommend annual mammograms beginning at age 40 for average-risk women," said Arasu. "Women who have been treated for cancer have a much higher risk of breast cancer than the general population. It makes no sense that they would follow the same mammography schedule as women with no history of breast cancer."

To examine the influence of mammogram frequency on outcomes, Arasu and colleagues reviewed the experience with their institution's post-lumpectomy surveillance protocol, which calls for semiannual mammography of the ipsilateral breast for the first five years after breast-conserving surgery.

Investigators reviewed records on patients who had conservative breast cancer surgery from 1997 through 2008. Mammography intervals of four to nine months were considered adherent with the institutional protocol, and intervals of nine months or more were considered nonadherent.

The primary outcome was mammographically identified ipsilateral breast cancer.

The analysis included 10,750 mammography examinations in 2,329 patients. Abnormalities were identified in 158 (1.5%) of the mammograms, leading to detection of 114 cancers and a positive biopsy rate of 72%.

The mammographic examinations consisted of 7,140 (84.8%) exams that met criteria for compliance and 1,281 judged to be noncompliant, including 1,065 that investigators considered representative of annual surveillance.

Arasu reported that 94% of cancers detected by semiannual surveillance mammography were stage 0 or 1 compared with 73% of cancers detected by annual mammography (P=0.021). The overall rates of earlystage disease included 90% versus 64% stage 1 (P=0.036) and 78% versus 53% minimal disease (P=0.059).

Semiannual mammography detected tumors that had a median size of 11.7 mm compared with 15.3 mm for annual surveillance (P=0.148). Additionally, 98% of new cancers identified by semiannual surveillance were node negative compared with 91% of cancers identified by annual surveillance (P=0.276).

"Obviously, the outcome of greatest interest is survival, but that takes many years of follow-up in thousands of women to assess," Arasu told MedPage Today. "What we can do is look at predictors of survival. One of the predictors is the size or stage of the cancer recurrence, just as it is in primary breast cancer. The bigger the recurrent tumor, the worse the outcome is. Our results sort of imply what the outcomes are."

Arasu reported no disclosures.

Primary source: American Roentgen Ray Society Source reference: Arasu V, et al "Outcomes analysis of

semiannual ipsilateral mammography surveillance following breast conservation therapy: 12-year

experience" ARRS 2010; Abstract 109.

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