The Role of Mammography and Physical Examination in Detecting Recurrent Tumor and Contralateral Breast Cancer for Patients with Stage I-II Breast Cancer Treated with Breast Conservation Treatment

Reviewer: John Wilson, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 20, 2003

Presenter: Changhu Chen
Presenter's Affiliation: University of Pennsylvania and University of Colorado
Type of Session: Scientific

Background

Breast cancer is the most common malignancy in women
Women who want to preserve their breast and are appropriate candidates can receive breast conservation treatment (BCT) which uses lumpectomy combined with postoperative radiation, thus avoiding a mastectomy
Mammography and breast exams are the standard of care for follow-up in patients who received BCT
When patients have a recurrence in the same breast or a contralateral breast tumor after BCT, it is unclear whether their is a relation between the modality that detected their first cancer (ie mammogram vs exam) and the modality that detected their recurrence or 2nd cancer.

Materials and Methods

1379 women with stage I and II invasive breast cancer were treated with BCT at the University of Pennsylvania from 1977 to 1995
The patients were followed with physical exam and yearly bilateral mammography
The modalities used to detect the primary tumor were compared with those used to detect patients who later developed an ipsilateral recurrence or contralateral breast cancer.

Results

125 patients developed ipsilateral recurrences and 71 patients developed contralateral breast cancers
For detection of ipsilateral recurrences: 38% were detected with mammogram alone, 37% physical exam alone and in 25% both were utilized
For detection of contralateral breast cancer: 53% were detected using mammogram alone, 23% physical exam alone and 24% were detected with both
When primary tumors were detected by mammography only, physical exam alone detected 22% of local recurrences and 19% of contralateral breast cancers
When primary tumors were detected by physical exam only, mammography alone detected 24% of local recurrences and 42% of contralateral breast cancers
When stratified by the interval between diagnosis of primary tumor and the diagnosis of recurrent or contralateral breast cancer (< or = 5 yrs vs. > 5 yrs), and age of recurrent or contralateral breast cancer (< or = 49 yrs vs. > or = 50 yrs) both physical exam and mammography were useful in detecting recurrent or contralateral breast cancer in each patient subgroup.

Author's Conclusions

Breast exam and mammography are essential in detecting ipsilateral recurrent breast cancer as well as contalateral breast cancer, regardless of which modality detected the primary tumor.

Clinical/Scientific Implications

This study is important because it shows that both breast physical exam and mammography are important in detecting recurrent or contralateral breast cancer. Even if one modality alone detected the primary tumor, at least one in five patients will have a recurrent or ipsilateral breast cancer detected by the other modality alone.

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