Australian and US collaborators provide evidence on outcomes of mammographic screening in previously affected women
Women with a personal history of breast cancer (PHBC) represent an increasing group of cancer survivors, and have a lifelong increased risk of developing a new or recurrent cancer in the conserved (ipsilateral) breast, or a contralateral cancer. The risk of a “second” breast cancer in women with PHBC has been estimated at 5.4 to 6.6/1000 woman-years.1 Evidence of screening benefit in PHBC women comes from observational studies2-4 and extrapolation of benefit from randomised mammographic screening trials; consensus-based recommendations include annual mammography in routine surveillance of PHBC women.5-7 Early detection may also minimise the physical and psychosocial burden and consequences of a second breast cancer. Evidence reviews have consistently acknowledged the lack of quality data on mammographic screening in PHBC women,4,8 and research into screening high-risk women has mostly focused on those with breast and ovarian cancer susceptibility genes; evaluation of screening in women with PHBC has received relatively little attention.4,8
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- 2. Houssami N, Ciatto S, Martinelli F, et al. Early detection of second breast cancers improves prognosis in breast cancer survivors. Ann Oncol 2009; 20: 1505-1510.
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- 4. Houssami N, Ciatto S. Mammographic surveillance in women with a personal history of breast cancer: how accurate? How effective? Breast 2010; 19: 439-445.
- 5. Khatcheressian JL, Wolff AC, Smith TJ, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol 2006; 24: 5091-5097.
- 6. Carlson RW, Allred DC, Anderson BO, et al. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 2009; 7: 122-192.
- 7. Hayes DF. Clinical practice. Follow-up of patients with early breast cancer. N Engl J Med 2007; 356: 2505-2513.
- 8. Grunfeld E, Noorani H, McGahan L, et al. Surveillance mammography after treatment of primary breast cancer: a systematic review. Breast 2002; 11: 228-235.
- 9. Houssami N, Abraham LA, Miglioretti DL, et al. Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA 2011; 305: 790-799.
- 10. BreastScreen Australia Evaluation Advisory Committee. BreastScreen Australia evaluation — evaluation final report. Screening Monograph No. 1/2009. Canberra: Australian Government Department of Health and Ageing, 2009. http://www.health.gov.au/internet/screening/publishing.nsf/Content/8463830B90E5BDF5CA25762A000193C6 (accessed Feb 2011).
We thank the Breast Cancer Surveillance Consortium investigators for supporting the research discussed in this editorial. Procedures for requesting Breast Cancer Surveillance Consortium data for research purposes are provided at http://breastscreening.cancer.gov. Nehmat Houssami receives support from National Health and Medical Research Council program grant 633003 to the Screening and Test Evaluation Program.
We had prominent roles in the design, conduct and publication of the study discussed in this editorial.9