What is the recommended duration for continuing mammograms in a 67-year-old patient with a history of breast cancer?

Mammographic Surveillance for a 67-Year-Old Patient with History of Breast Cancer

Women with a history of breast cancer should continue annual mammography screening as long as they remain in overall good health and have a life expectancy of at least 10 years, regardless of age. 1

Recommended Surveillance Protocol

• Annual mammography is the best imaging test for surveillance in patients with a history of breast cancer, with demonstrated reduction in mortality compared to those who do not undergo annual mammography 1
• The most common presentation of recurrent or second breast cancer in patients with a personal history of breast cancer is an abnormal mammogram in an otherwise asymptomatic patient 1
• Women with a personal history of breast cancer develop a second breast cancer at a rate of 5% to 10% within 5 to 10 years after initial diagnosis 1

Duration of Surveillance

• There is no upper age limit agreed upon for screening mammography 1
• Screening recommendations should be based upon life expectancy and competing comorbidities, rather than age alone 1
• Women should continue screening mammography as long as they:
  • Remain in overall good health 1
  • Have a life expectancy of at least 10 years 1, 2
  • Are willing to undergo the examination and subsequent testing or biopsy if an abnormality is identified 1

Frequency of Surveillance

• The American Society of Radiation Oncology (ASTRO) and National Comprehensive Cancer Network (NCCN) both recommend annual mammographic surveillance for women who have completed treatment for breast cancer 1
• For women treated with breast conservation therapy, the first post-treatment mammogram should be performed at 6 to 12 months after completion of radiation therapy 1
• Subsequent mammograms should be obtained annually for surveillance 1

Special Considerations for Older Patients

• More than one-third of all breast cancer deaths each year are attributable to women diagnosed after age 70 1
• Observational studies suggest that continuing annual mammography past age 75 may not result in substantial reductions in 8-year breast cancer mortality compared with stopping screening 3
• However, for women with a personal history of breast cancer (as in this case), the risk of recurrence or second primary cancer justifies continued surveillance 1

Risk Factors for Recurrence

• Factors that predict risk of locoregional recurrence include:
  • Age (younger patients have higher risk)
  • Tumor grade and size
  • Multifocality
  • Nodal involvement
  • Receptor status
  • Previous treatments (radiotherapy, chemotherapy, hormonal therapy) 1
• Most locoregional recurrences occur within 5 years after diagnosis, with recurrence risk greatest 2-3 years after initial therapy 1

Potential Pitfalls and Caveats

• There is suboptimal compliance with annual mammography in certain groups, particularly women over 65 years of age 1
• Some women may benefit from supplemental screening based on risk factors such as dense breast tissue or specific tumor characteristics (e.g., triple-negative or HER2-positive cancers) 1, 4
• Digital breast tomosynthesis (DBT) added to standard mammography has been shown to reduce recall rates and indeterminate findings in surveillance of patients with prior breast cancer history 1

For this 67-year-old patient with a history of breast cancer, annual mammography should be continued indefinitely as long as she remains in good health with a life expectancy of at least 10 years.