From the Guidelines
Yes, a diagnostic mammogram is necessary in the future if a previous mammogram was abnormal, as it allows for closer monitoring of the area of concern and can help detect any changes or potential recurrences early on. This approach is supported by the American College of Radiology (ACR) and other organizations, which recommend annual mammography for surveillance in patients with a personal history of breast cancer 1. The use of diagnostic mammography in this context is particularly important, as it can help reduce mortality compared to women with a history of breast cancer who do not receive annual mammography 1.
Some key points to consider when it comes to diagnostic mammograms after an abnormal previous mammogram include:
- The most common presentation of a recurrent or second breast cancer in patients with a personal history of breast cancer is an abnormal mammogram in an otherwise asymptomatic patient 1
- Most locoregional recurrences occur within 5 years after diagnosis, with recurrence risk greatest 2 to 3 years after initial therapy 1
- The addition of Digital Breast Tomosynthesis (DBT) to 2-D digital mammography or 2-D synthetic images in the surveillance of patients with prior breast cancer history has been shown to reduce recall rates and indeterminate findings 1
- Annual mammographic surveillance is recommended for women who have completed radiation therapy as part of breast conservation therapy, with the first imaging performed at 6 to 12 months 1
It's also important to note that the decision to transition back to screening mammograms would be based on the specific nature of the original abnormality, overall risk factors, and the stability of findings over time. Ultimately, following the healthcare provider's specific recommendations is crucial, as they will consider the complete medical history when determining the appropriate screening protocol.
From the Research
Necessity of Diagnostic Mammogram after Abnormal Result
- A diagnostic mammogram may be necessary after an abnormal result to confirm the presence of invasive cancer, in situ cancer, or a nonmalignant process 2
- The mammographic report should provide clear information on whether a biopsy must be performed or if the abnormality will be reviewed with a repeat X-ray examination in 6-month intervals until the nature of the abnormality is determined 2
Follow-up of Abnormal Mammograms
- Follow-up of abnormal mammogram results is an essential component of safe breast care, and missed or delayed follow-up can lead to potential harm to patients and medical malpractice liability 3
- A paper-based fail-safe system for abnormal mammograms can help ensure timely follow-up, but special care is warranted to ensure full clinician adherence and address staff transitions and trainee-related issues 3
- Inadequate follow-up of abnormal mammograms can occur, especially among women who require six-month follow-up, and is associated with lower estimated household income and no history of previous mammogram 4
Management of Abnormal Mammograms
- A clinical algorithm for the management of abnormal mammograms can help reduce the incidence of unnecessary surgical procedures and improve the positive predictive value of breast biopsies 5
- Organizational communication factors, such as direct verbal communication, explanation of medical processes, and use of interpretation services, can facilitate timely follow-up for abnormal mammogram results and minimize patient distress 6
- Health organizations with more robust support staff, such as bilingual navigators, can improve follow-up times and patient understanding of results 6