UCLA study: Routine imaging may offer little benefit after mastectomy
Routine Screening Frequency After Double Mastectomy for Early Breast Cancer
Half of the patients reviewed in a recent UCLA Health Jonsson Comprehensive Cancer Center study continued to receive routine breast imaging after undergoing a double mastectomy for ductal carcinoma in situ, despite guidelines remaining uncertain due to minimal remaining tissue. Researchers examining medical records of 90 patients treated between 2017 and 2019 tracked 154 imaging examinations performed over a median follow-up of nearly six years. The findings, published in Surgical Oncology Insight, reveal that routine screening detected only one out of four cancer recurrences during the study period, while symptomatic changes prompted the discovery of the remaining three cases.
- Routine mammograms, ultrasounds, and MRIs after bilateral mastectomy for stage 0 breast cancer identified just a single recurrence in an asymptomatic patient.
- Primary care physicians and OB-GYNs accounted for nearly half of all post-surgical imaging orders and 60% of routine screening examinations.
- Twelve imaging examinations led to biopsies in nine patients, resulting in eight benign findings and four cancer diagnoses.
Physicians Order Imaging Tests Inconsistently Following Breast Reconstruction
The UCLA team documented a total of 154 postoperative imaging tests among the 90 study participants, yet the utilization of mammography, ultrasound, and MRI showed no consistent relationship with patient age, genetic risk, tumor size, or type of breast reconstruction. These findings indicate that clinical choices regarding screening might be driven by individual physician preferences rather than being systematically based on a patient’s specific risk profile. Primary care and OB-GYN physicians accounted for nearly half of all imaging orders and 60% of routine screening examinations, showing a potential need for greater education about appropriate follow-up care after double mastectomy.
Unlike patients who undergo breast-conserving surgery, who generally continue receiving mammograms to monitor remaining breast tissue, women who have both breasts removed face a very low risk of recurrence because very little breast tissue remains. Unnecessary imaging can lead to false-positive results, additional biopsies, medical costs, and anxiety for patients. Senior author Dr. Our findings raise an important question about the value of continued screening after cancer treatment for women with DCIS,
said Dr. Kapoor. By helping physicians better understand when imaging is necessary, we can reduce unnecessary testing while ensuring patients continue to receive the care that’s most appropriate for them.
Unresolved Guidance Gaps in Post-Mastectomy Care
Medical organizations maintain varying recommendations for imaging following mastectomy, leaving clinicians and patients without uniform standards. Although standard surveillance is not highly effective for those without symptoms, it remains vital to conduct periodic clinical check-ups and immediately investigate any new lumps, skin changes, swelling, or other suspicious symptoms. In addition to Dr.
Despite these findings, questions remain regarding how to standardize follow-up protocols across different specialties to ensure that patients are not subjected to unnecessary procedures while still receiving adequate monitoring for potential symptoms.
Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.