Benefit of semiannual ipsilateral mammographic surveillance following breast conservation therapy

Abstract

Purpose: To compare cancer recurrence outcomes on the basis of compliant semiannual versus noncompliant annual ipsilateral mammographic surveillance following breast conservation therapy (BCT).

Materials and methods: A HIPAA-compliant retrospective review was performed of post-BCT examinations from 1997 through 2008 by using a deidentified database. The Committee on Human Research did not require institutional review board approval for this study, which was considered quality assurance. Groups were classified according to compliance with institutional post-BCT protocol, which recommends semiannual mammographic examinations of the ipsilateral breast for 5 years. A compliant semiannual examination was defined as an examination with an interval of 0-9 months, although no examination had intervals less than 3 months. A noncompliant annual examination was defined as an examination with an interval of 9-18 months. Cancer recurrence outcomes were compared on the basis of the last examination interval leading to diagnosis.

Results: Initially, a total of 10 750 post-BCT examinations among 2329 asymptomatic patients were identified. Excluding initial mammographic follow-up, there were 8234 examinations. Of these, 7169 examinations were semiannual with 94 recurrences detected and 1065 examinations were annual with 15 recurrences detected. There were no differences in demographic risk factors or biopsy rates. Recurrences identified at semiannual intervals were significantly less advanced than those identified at annual intervals (stage I vs stage II, P = .04; stage 0 + stage I vs stage II, P = .03). Nonsignificant findings associated with semiannual versus annual intervals included smaller tumor size (mean, 11.7 vs 15.3 mm; P = .15) and node negativity (98% vs 91%, P = .28).

Conclusion: Results suggest that a semiannual interval is preferable for ipsilateral mammographic surveillance, allowing detection of a significantly higher proportion of cancer recurrences at an earlier stage than noncompliant annual surveillance.

Proportions of patients with asymptomatic invasive cancer recurrence according to stage of cancer recurrence and surveillance interval. Routine surveillance mammograms were acquired every 6 months for 5 years following BCT. Cohort assignments were based on compliance with semiannual examinations compared with noncompliance with annual examinations. Semiannual-interval surveillance mammography depicted a significantly higher proportion of asymptomatic stage I cancer recurrences than annual-interval surveillance mammography (P = .04). When including noninvasive recurrences (not shown), semiannual-interval surveillance mammography continued to depict more stage 0 + stage I recurrences than stage ‖ recurrences (P = .03).