Breast Cancer Research and Treatment

, Volume 171, Issue 1, pp 209–215 | Cite as

Predictors of surveillance mammography outcomes in women with a personal history of breast cancer

  • Kathryn P. LowryEmail author
  • Lior Z. Braunstein
  • Konstantinos P. Economopoulos
  • Laura Salama
  • Constance D. Lehman
  • G. Scott Gazelle
  • Elkan F. Halpern
  • Catherine S. Giess
  • Alphonse G. Taghian
  • Janie M. Lee



To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features.


This study was HIPAA compliant and IRB approved. We performed an electronic medical record review for a cohort of women with American Joint Committee on Cancer (AJCC) Stage I or II invasive breast cancer treated with breast conservation therapy who developed subsequent in-breast treatment recurrence (IBTR) or contralateral breast cancer (CBC). Poor surveillance outcome was defined as second breast cancer not detected by surveillance mammography, including interval cancers (diagnosed within 365 days of surveillance mammogram with negative results) and clinically detected cancers (diagnosed without a surveillance mammogram in the preceding 365 days). Univariate and multivariate logistic regression were performed to identify predictors of poor mammography surveillance outcome, including patient and primary tumor characteristics, breast density, mode of primary tumor detection, and time to second cancer diagnosis.


164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis < 50 years (p < 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age < 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001).


Women younger than age 50 at primary breast cancer diagnosis are at risk of poor surveillance mammography outcomes, and may be appropriate candidates for more intensive clinical and imaging surveillance.


History of breast cancer Surveillance Screening outcomes Mammography 



This work was supported by a Resident Research Grant from the Radiological Society of North America (KPL).

Compliance with ethical standards

Conflict of interest

EH is a research consultant for Hologic, Inc. and Real Imaging Ltd. GSG is a consultant for General Electric Healthcare. CDL serves on the Research Grant and Advisory Board for General Electric Healthcare. AGT is a consultant for VisionRT. JML receives a Research Grant from General Electric Company.

Ethical approval

This study complies with U.S. law. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER cancer statistics review, 1975–2014, National Cancer Institute, Bethesda, MD., based on November 2016 SEER data submission, posted to the SEER web site, April 2017
  2. 2.
    Khatcheressian JL et al (2013) Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(7):961–965CrossRefPubMedGoogle Scholar
  3. 3.
    Schnipper LE et al (2012) American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol 30(14):1715–1724CrossRefPubMedGoogle Scholar
  4. 4.
    National Comprehensive Cancer Network (2015) NCCN clinical practice guidelines in oncology: breast cancer (version 3.2014). Accessed 1 Jan 2015
  5. 5.
    Runowicz CD et al (2016) American Cancer Society/American Society of clinical oncology breast cancer survivorship care guideline. J Clin Oncol 34(6):611–635CrossRefPubMedGoogle Scholar
  6. 6.
    Moy L et al (2016) ACR appropriateness criteria stage I breast cancer: initial workup and surveillance for local recurrence and distant metastases in asymptomatic women. J Am Coll Radiol 13(11S):e43–e52Google Scholar
  7. 7.
    Lu WL 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 Res Treat 114(3):403–412CrossRefPubMedGoogle Scholar
  8. 8.
    Houssami N et al (2009) Early detection of second breast cancers improves prognosis in breast cancer survivors. Ann Oncol 20(9):1505–1510CrossRefPubMedGoogle Scholar
  9. 9.
    Houssami N et al (2011) Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA 305(8):790–799CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Houssami N et al (2013) Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening. Cancer Epidemiol Biomark Prev 22(5):946–961CrossRefGoogle Scholar
  11. 11.
    Lehman CD et al (2017) National performance benchmarks for modern screening digital mammography: update from the breast cancer surveillance consortium. Radiology 283(1):49–58CrossRefPubMedGoogle Scholar
  12. 12.
    Sorlie T et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98(19):10869–10874CrossRefPubMedGoogle Scholar
  13. 13.
    Goldhirsch A et al (2011) Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St. Gallen international expert consensus on the primary therapy of early breast cancer 2011. Ann Oncol 22(8):1736–1747CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Coates AS et al (2015) Tailoring therapies–improving the management of early breast cancer: St Gallen international expert consensus on the primary therapy of early breast cancer 2015. Ann Oncol 26(8):1533–1546CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Reis-Filho JS, Pusztai L (2011) Gene expression profiling in breast cancer: classification, prognostication, and prediction. Lancet 378(9805):1812–1823CrossRefPubMedGoogle Scholar
  16. 16.
    Sotiriou C, Pusztai L (2009) Gene-expression signatures in breast cancer. N Engl J Med 360(8):790–800CrossRefPubMedGoogle Scholar
  17. 17.
    Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, FranceGoogle Scholar
  18. 18.
    Arvold ND et al (2011) Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol 29(29):3885–3891CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Braunstein LZ et al (2015) Outcome following local-regional recurrence in women with early-stage breast cancer: impact of biologic subtype. Breast J 21(2):161–167CrossRefPubMedGoogle Scholar
  20. 20.
    D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA et al (2013) ACR BI-RADS® atlas, breast imaging reporting and data system. American College of Radiology, Reston, VAGoogle Scholar
  21. 21.
    D’Orsi CJ, Mendelson EB, Ikeda DM et al (2003) Breast imaging reporting and data system: ACR BI-RADS—breast imaging atlas. American College of Radiology, Reston, VAGoogle Scholar
  22. 22.
    Cho N, Han W, Han B, Bae MS, Ko ES, Nam SJ, Chae EY, Lee JW, Kim SH, Kang BJ, Song BJ, Kim E, Moon HJ, Kim SI, Kim SM, Kang E, Choi Y, Kim HH, Moon WK (2017) Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years or younger at diagnosis and treated with breast conservation therapy. JAMA Oncol 3(11), 1495–1502CrossRefGoogle Scholar
  23. 23.
    Wirtz HS et al (2014) Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors. Breast Cancer Res Treat 143(3):541–550CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Domingo L et al (2014) Tumor phenotype and breast density in distinct categories of interval cancer: results of population-based mammography screening in Spain. Breast Cancer Res 16(1):R3CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Caldarella A et al (2013) Biological characteristics of interval cancers: a role for biomarkers in the breast cancer screening. J Cancer Res Clin Oncol 139(2):181–185CrossRefPubMedGoogle Scholar
  26. 26.
    Wedam SB, Swain SM (2005) Contralateral breast cancer: where does it all begin? J Clin Oncol 23(21):4585–4587CrossRefPubMedGoogle Scholar
  27. 27.
    Swain SM et al (2004) Estrogen receptor status of primary breast cancer is predictive of estrogen receptor status of contralateral breast cancer. J Natl Cancer Inst 96(7):516–523CrossRefPubMedGoogle Scholar
  28. 28.
    Huo D et al (2011) Concordance in histological and biological parameters between first and second primary breast cancers. Cancer 117(5):907–915CrossRefPubMedGoogle Scholar
  29. 29.
    Brown M, Bauer K, Pare M (2010) Tumor marker phenotype concordance in second primary breast cancer, California, 1999–2004. Breast Cancer Res Treat 120(1):217–227CrossRefPubMedGoogle Scholar
  30. 30.
    Arpino G et al (2005) Hormone receptor status of a contralateral breast cancer is independent of the receptor status of the first primary in patients not receiving adjuvant tamoxifen. J Clin Oncol 23(21):4687–4694CrossRefPubMedGoogle Scholar
  31. 31.
    Lee JM et al (2015) Five-year risk of interval-invasive second breast cancer. J Natl Cancer Inst 107(7)Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kathryn P. Lowry
    • 1
    • 8
    Email author
  • Lior Z. Braunstein
    • 2
  • Konstantinos P. Economopoulos
    • 3
  • Laura Salama
    • 4
  • Constance D. Lehman
    • 5
  • G. Scott Gazelle
    • 5
  • Elkan F. Halpern
    • 5
  • Catherine S. Giess
    • 6
  • Alphonse G. Taghian
    • 7
  • Janie M. Lee
    • 1
  1. 1.Department of Radiology, Seattle Cancer Care AllianceUniversity of Washington School of MedicineSeattleUSA
  2. 2.Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of SurgeryDuke University Medical CenterDurhamUSA
  4. 4.Department of Internal MedicineFlorida Atlantic UniversityBoca RatonUSA
  5. 5.Department of RadiologyMassachusetts General HospitalBostonUSA
  6. 6.Department of RadiologyBrigham and Women’s HospitalBostonUSA
  7. 7.Department of Radiation OncologyMassachusetts General HospitalBostonUSA
  8. 8.Division of Breast ImagingSeattle Cancer Care AllianceSeattleUSA

Personalised recommendations