Abstract P3-01-03: Are six-month follow up mammograms necessary after breast conserving surgery and radiation therapy?
Authors: Kaufman Chavi , Fulop Tamara , Boolbol Susan K , Lucido David , Naam Suzan , Gillego Alyssa , Chadha Manjeet 
Published: May 2015

Background: In an era of choosing wisely in healthcare there are many initiatives in radiology and oncology that are being evaluated for appropriateness of practice, as based on clinical evidence. Six month ipsilateral follow up mammogram protocol, in the initial 2-3 years after BCT, is widely accepted. However, there is limited data that support the value of q 6-month post- BCT mammogram schedule, the associated patient anxiety, and additional biopsy procedures. The goal of our study was to evaluate the frequency of BIRADS 4 reports on early (≤ 3 years) follow-up mammograms after unilateral breast conserving surgery and RT (BCT).

Materials and Methods: This is an IRB approved study. From 2001- 2007, we identified 681 patients who underwent BCT, and who also underwent follow up mammograms at our cancer center. We reviewed early follow up mammograms defined as those obtained within the initial 3-years after BCT. The BIRADS score was tabulated in all cases. The study evaluated the frequency of BIRADS 4, in either breast because this finding routinely warrants additional evaluation.

Results: Median age of the study group is 51 years (31- 80 years). Among the 681 patients a total of 3648 follow up mammogram studies were obtained. The median number of follow up mammogram studies per patient during the 3-year observation period was 6 (range 2-6 mammogram sessions). In 85% of patients the mammogram reported BIRADS 1 to 3. In 15% of the patients a BIRADS 4 had been reported at least once in either breast. Among the 103 patients with BIRAD 4 reported on mammogram, 56% had this score reported in the ipsilateral breast following BCT for breast cancer, and 44% had this reported in the contralateral breast. Specifically, the frequency of BIRADS 4 in the ipsilateral breast was 8.2%. In the first year of follow up, we observed a significant trend with a higher frequency (22%) of BIRADS 4 reported in the ipsilateral breast as compared with the contralateral breast (7%). In the 2nd and 3rd year the frequency of BIRADS 4 was &lt; 10% and comparable between the treated ipsilateral and contralateral breast. The pathology correlations showed a significantly lower yield of cancer in the ipsilateral BIRADS 4 subset of patients.

Conclusions: Similar to the observations of the ACRIN 6666 study 1 on BIRADS 3, we observed a very low yield of cancer when correlating imaging to final pathology. The generally accepted protocol for every six month ipsilateral mammogram, in the 3 years after BCT, may not be necessary in the majority of patients and annual mammograms might, in fact, be acceptable. In a time when responsible medical care is promoting the practice of use gently and wisely, it is important to establish appropriate follow up guidelines. There may be benefit in optimizing follow up care by using schedules individualized by risk. Similar studies are needed for evaluation of clinical outcomes and establishing standardized protocols.

1 ACRIN 6666 study, Radiology 2013

This study is funded by the Ellen Blair Grant.

Citation Format: Chavi Kaufman, Tamara Fulop, Susan K Boolbol, David Lucido, Suzan Naam, Alyssa Gillego, Manjeet Chadha. Are six-month follow up mammograms necessary after breast conserving surgery and radiation therapy? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-01-03.