Abstract P4-01-07: Recall for assessment after post-treatment surveillance mammograms in breast cancer
Authors: Wassermann M , Swinson C , Shrestha D , Kirkpatrick K , Ravichandran D 
Published: May 2016

Background: Patients treated for breast carcinoma are usually followed up with regular mammograms. The aims are early diagnosis of locally recurrent disease in the ipsilateral breast or new cancers in the contralateral breast, and to provide reassurance. When the mammograms are considered abnormal patients are recalled for further assessment. The aim of this study is to review all mammographic recalls in a single institution over a 5-year period to study the patient population recalled, reasons for the recall and the outcome.

Materials and Methods: We identified all breast cancer patients who were recalled for assessment following a routine post-treatment surveillance mammogram from April 2010 to March 2015 from the breast unit database. We reviewed their original presentation with breast cancer, treatment received, reason for recall, the assessment process and the outcome. The mammographic follow-up policy of the unit during the study period was as follows; after breast conserving surgery (BCS), yearly bilateral mammograms for 5 years or until the age of 50 whichever the later; following mastectomy, mammogram of the opposite breast at years 1, 3 and 5 post-surgery, and if the patient is aged under 50 after 5 years, 2-yearly till 50 years of age. Patients were then discharged to UK National Breast Screening Programme where mammograms are performed 3-yearly.

Results: During the study period 1809 patients had 3685 surveillance mammograms. 149 patients were recalled (a recall rate of 8% of patients and 4% of mammograms over 5-years). 122 patients had BCS and 27 patients had mastectomy. The original diagnosis was invasive cancer in 131 and DCIS in 18. The reason for recall was a density or mass in 63, microcalcification in 61, distortion in 14 and a mixture of these or other reasons in 11. Eighty one patients were recalled for a problem on the ipsilateral side and 66 for contralateral side (2 patients had bilateral cancer).

Among 149 patients recalled, 50 had further imaging only (further mammographic views, ultrasound or both) after the recall and 79 underwent a needle biopsy under ultrasound or stereo guidance. 8 patients underwent US-guided aspiration of benign cysts. 21 biopsy results were malignant. The final diagnosis was ipsilateral recurrence in 10 patients and contralateral cancer in 11.

Conclusions: There is not much published data in the literature on the outcome of post-treatment surveillance mammograms despite the fact that such mammographic surveillance is commonly practiced. This study shows that over a 5-year period, 8% of the patients and 4% of the mammograms were recalled. A third of patients recalled only required further imaging. Although biopsies were performed in over half the patients, only 14% of patients recalled were proved to have ipsilateral or contralateral carcinoma after the assessment.

Citation Format: Wassermann M, Swinson C, Shrestha D, Kirkpatrick K, Ravichandran D. Recall for assessment after post-treatment surveillance mammograms in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-01-07.