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
Ultima Vez Modificado: 20 de octubre del 2003

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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.

Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Siemens Medical Solutions.


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