Importance of Regular Screening for Recurrence

The overall risk of breast cancer recurrence is small in most cases, but anything more than 0% risk can provoke fear. People tend to respond to this fear in one of two ways. Some become hypersensitive to any change in their body, even normal changes that are involved in the process of aging. These people may medical care often, only to find that nothing is wrong. Family and friends may see them as paranoid, hypersensitive or unable to move forward with their lives.

The other response is denial. These people may ignore pain or symptoms that they have and avoid going to their doctor’s appointments because they are afraid to hear what might be happening. Often, breast cancer recurrence is more aggressive than the original cancer, as it was able to survive treatment. When these patients deny what might be happening, the cancer may be very advanced before they do seek medical attention. This is frequently a fatal mistake, as the success of treatment for recurrence dwindles with advancing stages.

The Use of Mammograms

Mammograms are an important part of breast cancer screening, even for recurrence. If a mastectomy is done on one side, the other breast can still be imaged by mammogram for screening. If a partial mastectomy is done, then a mammogram should definitely be a part of screening for recurrence.1 At the time of surgery, clips are typically placed in the location that the cancer was, making it easier on subsequent mammograms to pay closer attention to this area. Local recurrences are generally in or near the pocket where the tumor was.

Clinical Breast Examinations

Clinical breast examination together with mammogram is important for early detection of recurrence. Even patients that have had double mastectomies still need to have clinical breast examinations of the chest wall and lymph node basin. A mastectomy will remove almost all of the breast tissue, however, it is not possible to remove every cell. If you notice something different in your breast, chest wall or armpit area, make sure to communicate this to your doctor and have them examine it.3

Benefits of Regular Screening

The major benefit of routine breast cancer recurrence screening is that early detection and early treatment of recurrence will yield the greatest survival. A review of several studies concerning recurrence found that recurrences found by mammography had a greater survival compared to those found by clinical breast exam. This is because mammogram can pick up microcalcifications before a lump or new mass can be felt on exam. Early detection is predicted to prevent mortality from breast cancer recurrence in 17-28% of all mortalities recurrences.4

References

1 Park, C. C., Rembert, J., Chew, K., et al. (2009). High Mammographic Breast Density Is Independent Predictor of Local But Not Distant Recurrence After  Lumpectomy and Radiotherapy for Invasive Breast Cancer. International Journal of Radiation Oncology Biology Physics , 75-79.

2 Cil, T., Fishell, E., Hanna, W., et al. (2009). Mammographic density and the risk of breast cancer recurrence after breast-conserving surgery. Cancer , 5780-5787.

3 Israel, O., & Kuten, A. (2007). Early Detection of Cancer Recurrence: 18F-FDG PET/CT Can Make a Difference in Diagnosis and Patient Care . Journal of Nuclear Medicine , 285-355.

4 Lu, W. L., Post, W. J., Bonnema, J., et al. (2009). Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis . Breast Cancer , 403-412.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.