Mammography Follow-up After Benign Breast Biopsy
After a benign breast biopsy result, patients should return to routine annual screening mammography rather than short-term follow-up imaging. 1
General Recommendations Based on Biopsy Type
Non-Atypical Lesions
- For benign breast biopsies showing nonproliferative lesions (cysts, fibroadenomas, lipomas) or proliferative lesions without atypia (usual ductal hyperplasia, sclerosing adenosis), routine annual screening is recommended 1
- Studies have shown that 6-month follow-up imaging compared to routine annual screening did not improve cancer detection rates or change outcomes such as invasive cancer rates, stage, tumor size, or nodal status in these patients 1, 2, 3
- Short-term (6-month) follow-up imaging did not contribute to improved breast cancer detection in patients with concordant benign results 2, 3
Atypical Lesions
- For proliferative lesions with atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, LCIS, flat epithelial atypia), management varies and may require more intensive surveillance 1
- Atypical ductal hyperplasia found on core biopsy typically warrants surgical consultation and/or multidisciplinary discussion regarding excision 1
- Management of atypical lobular hyperplasia, LCIS, and flat epithelial atypia found on core biopsy has more varied practice 1, 4
Imaging Modality Recommendations
- The American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommend annual screening mammography for all asymptomatic women age 40 and older, including those with history of benign breast biopsy 1
- Digital breast tomosynthesis (DBT) is preferred over standard mammography as it increases cancer detection rates and decreases false-positive recall rates 4
- For women with atypical lesions, supplemental screening with MRI may be warranted due to their elevated risk of developing breast cancer 4
Important Considerations
- Benign breast disease is an independent risk factor for developing breast cancer, with almost 30% of women with breast cancer having a history of benign breast disease 1
- A large study of over 2 million screening mammograms showed no difference in mammographic sensitivity in women with prior benign breast biopsies, but did show decreased specificity 1
- The cancer detection rate at 6-month follow-up after benign concordant biopsy is extremely low (0% in multiple studies), supporting the recommendation for routine annual screening rather than short-interval follow-up 2, 3
Special Circumstances
- If there is discordance between imaging and pathology findings, additional evaluation is needed 1
- For BI-RADS category 3 lesions (probably benign), follow-up with diagnostic mammograms at 6 months, then every 6-12 months for 1-2 years is recommended 1, 5
- If a lesion increases in size or changes its benign characteristics during follow-up, a biopsy should be performed 1, 5
Conclusion for Clinical Practice
For patients with benign breast biopsy results that are concordant with imaging findings, routine annual screening mammography is appropriate and short-interval (6-month) follow-up imaging is not necessary. 1, 2, 3