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Recommendation
Imaging after breast-conserving surgery – Routine surveillance
Patients who have undergone breast-conserving surgery should be referred for annual mammography of both breasts.
Patients who have undergone a unilateral mastectomy should be referred for annual mammography on the intact breast.
Patients may choose to return to BreastScreen for routine annual mammographic surveillance after 5 years.
Consider the addition of ultrasound to mammography for follow-up, when indicated on clinical or radiological grounds.
It is recommended that primary care clinicians should refer women who have received a unilateral mastectomy for annual mammography on the intact breast and, for those with lumpectomies, an annual mammography of both breasts (Level of evidence 2A – NCCN guidelines)
A “strong” rating was assigned when the observed consensus agreement was between 90% and 100%
A “moderate” rating was assigned when the observed consensus agreement was less than 90%
How this guidance was developed
This recommendation was adapted from the ACS/ASCO 2016 guidelines (US). The source recommendation was based on a systematic review of the evidence conducted to April 2015 and was not graded by the source guideline authors. The source recommendation was adapted by making it gender neutral, and to reflect the fact that all clinicians, not just GPs, can be responsible for referring patients for mammography. The use of ultrasound (when there is an unexplained symptom requiring further investigation) was added. A recent systematic review of breast imaging surveillance across guidelines published Jan 2007-Jan 2017 (Swinnen et al. 2018) is noted.
The recently released ASCO 2020 guideline on the management of male breast cancer is noted. This guideline, based on a systematic review of the evidence to 20 September 2019, indicates that ‘Ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy, if technically feasible, regardless of genetic predisposition’ (Type: formal consensus; evidence quality: low; strength of recommendation: strong) and that ‘Contralateral annual mammography should be offered to men with a history of breast cancer and a genetic predisposing mutation’ (Type: formal consensus; evidence quality: low; Strength of recommendation: moderate).
Related guidance by topic
Imaging after breast-conserving surgery – Routine surveillance
Recommendation
Patients who have undergone breast-conserving surgery should be referred for annual mammography of both breasts.
Patients who have undergone a unilateral mastectomy should be referred for annual mammography on the intact breast.
Patients may choose to return to BreastScreen for routine annual mammographic surveillance after 5 years.
Consider the addition of ultrasound to mammography for follow-up, when indicated on clinical or radiological grounds.
Principles in action
Safe and quality care
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Multidisciplinary care
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Supportive care
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Care coordination
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Communication
This recommendation was adapted from the ACS/ASCO 2016 guidelines (US). The source recommendation was based on a systematic review of the evidence conducted to April 2015 and was not graded by the source guideline authors. The source recommendation was adapted by making it gender neutral, and to reflect the fact that all clinicians, not just GPs, can be responsible for referring patients for mammography. The use of ultrasound (when there is an unexplained symptom requiring further investigation) was added. A recent systematic review of breast imaging surveillance across guidelines published Jan 2007-Jan 2017 (Swinnen et al. 2018) is noted.
The recently released ASCO 2020 guideline on the management of male breast cancer is noted. This guideline, based on a systematic review of the evidence to 20 September 2019, indicates that ‘Ipsilateral annual mammogram should be offered to men with a history of breast cancer treated with lumpectomy, if technically feasible, regardless of genetic predisposition’ (Type: formal consensus; evidence quality: low; strength of recommendation: strong) and that ‘Contralateral annual mammography should be offered to men with a history of breast cancer and a genetic predisposing mutation’ (Type: formal consensus; evidence quality: low; Strength of recommendation: moderate).
Related guidance by topic
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