Breast Mammography Surveillance

Scottish Cancer Network: Clinical Management Pathways
NHS National Services Scotland
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This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of these guidelines, taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols. 

Introduction

This document is for patients diagnosed with early breast cancer or Ductal Carcinoma In Situ (DCIS) outlining surveillance recommendations. It remains the responsibility of clinical team to interpret the application of these guidelines, the needs, co-morbidities, and individual circumstances of the patient as well as local service constraints should be taken into account.

Patients who have had breast conserving surgery and have been deemed to be at increased risk of a further breast cancer (either due to a pathogenic/likely pathogenic variant in a cancer predisposition gene or family history), should have surveillance appropriate to this. 

Ductal Carcinoma In Situ (DCIS)

For Ductal Carcinoma In Situ (DCIS) it is recommended that there is annual mammography for a minimum of 5 years or until age 50. Then as per national screening programme.

Wide Local Excision (WLE) Surgery – High Risk

The results of the mammo50 trial are awaited and will be incorporated when published in a Peer Review Journal. 

Annual mammography for patients undergoing Wide Local Extension (WLE) surgery depends on the patient risk criteria. 

Definition of high-risk patients:

  • triple negative 
  • HER2 positive  
  • node positive 
  • under 50

Annual mammography for a minimum of 5 years or until 50. Then as per national screening programme.

Wide Local Excision (WLE) Surgery – Low Risk

The results of the mammo50 trial are awaited and will be incorporated when published in a Peer Review Journal. 

Definition of low-risk patients: 

  • ER positive 
  • > 50 years 

Annual mammography for a minimum of 5 years or until 50. Then as per national screening programme.

Mastectomy

Women who have had a mastectomy: 

  • < 50 years, annual mammography for 5 years or until age 50, then as per national screening. 
  • 50-70 years, offer 2 yearly mammography at years 1, 3 and 5, then as per national screening. 
  • > 70 years, offer 2 yearly mammography at years 1, 3 and 5, then can self-refer for national screening.

Breast cancer in men

Men should be considered for the same mammographic follow up of residual breast tissue as women1.

 

Occult cancers

If a patient has had Wide Local Extension (WLE) surgery for mammographically occult tumour and this has been confirmed at MDT by radiology, then in addition to surveillance mammography, MRI annually for 5 years, could be offered.

Cancers in young women

In young woman with very dense breasts (BIRADS D) treated with breast conserving surgery, annual MRI up to the age of 35 years, could be offered.

References

  1. RCR Guidance on screening and symptomatic breast imaging fourth edition (2019).

Editorial Information

Last reviewed: 08/03/2024

Next review date: 08/03/2027

Author(s): Karen Gray on behalf of the Breast Cancer Imaging Subgroup.

Version: 1

Reviewer name(s): Frances Yuille.