From the Guidelines
After breast cancer surgery and treatment, surveillance typically includes annual mammograms, regular clinical breast exams every 3-6 months for the first 3 years, then every 6-12 months for the next 2 years, and annually thereafter, as recommended by the most recent guidelines 1. The following are key points to consider:
- Patients should also perform monthly breast self-examinations to detect any changes.
- For those who underwent breast-conserving surgery, the first post-treatment mammogram should be obtained 6-12 months after radiation completion, then annually.
- Patients with genetic mutations or high risk may require more intensive surveillance, potentially including breast MRI.
- Additional monitoring may include bone density scans for those on aromatase inhibitors and regular gynecological exams for patients on tamoxifen.
- These surveillance measures are crucial for detecting recurrence or new primary cancers early when they're most treatable.
- The risk of recurrence is highest in the first 2-3 years after treatment, which explains the more frequent follow-ups during this period.
- Patients should report any new symptoms promptly, including new breast lumps, chest wall changes, persistent bone pain, or unexplained weight loss, as these could indicate recurrence, as supported by recent studies 1.
Some studies have shown that more frequent imaging, such as every 6 months, may not provide additional benefits in terms of survival or detection of recurrence 1. However, the use of digital breast tomosynthesis (DBT) has been shown to improve the detection of breast cancer and reduce the recall rate compared to traditional mammography 1. Ultimately, the specific surveillance plan should be individualized based on the patient's risk factors, medical history, and personal preferences, with consideration of the latest evidence and guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Screening Measures After Surgery
For breast cancer patients after surgery and treatment, the following screening measures are used as surveillance:
- Annual screening mammograms, which have been shown to be cost-effective and credited for the decline in mortality of breast cancer 2
- Breast magnetic resonance imaging (MRI) for early breast cancer detection in asymptomatic women 2
- Serum tumor markers, such as CA 15-3, carcinoembryonic antigen (CEA), and CA 27-29, which are ordered in the clinic mainly for disease surveillance 2, 3, 4, 5
- Clinical breast examinations 6
- Emerging screening technologies, such as blood-based markers and breast-based markers, like nipple/ductal fluid 2
Tumor Markers
Tumor markers, such as CA 15-3, have been found to be useful in monitoring therapeutic response in breast cancer patients:
- CA 15-3 has a sensitivity ranging from 75-76.9% and specificity ranging from 85.5-93% in the diagnostic and follow-up of patients with breast cancer 3
- CA 15-3 levels are elevated in patients with metastatic breast cancer, and can be used to detect bone metastases in association with bone scan 3, 5
- Combination of CA 15-3 and CA 27-29 improves sensitivity in detecting bone lesions 4
Surveillance Strategies
Surveillance strategies for breast cancer patients after surgery and treatment may include:
- Regular monitoring of serum tumor marker levels, such as CA 15-3 and CA 27-29 3, 4, 5
- Annual screening mammograms and clinical breast examinations 2, 6
- Breast MRI for high-risk patients or those with dense breast tissue 2
- Skeletal scintigraphy for patients with clinical stage III and IV disease or high levels of CA 15-3 3