Recommendations for breast imaging follow-up of women with a previous history of breast cancer: position paper from the Italian Group for Mammography Screening (GISMa) and the Italian College of Breast Radiologists (ICBR) by SIRM

Abstract

Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0–1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15–20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient’s age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness.

Health care services use among long-term breast cancer survivors: a systematic review

“…Overall, the available evidence indicates that primary healthcare providers should place greater emphasis on post-treatment symptoms to make patients aware of them and provide advice on their management. To do this, the best option seems to be the shared care model since it can facilitate a continued relationship in terms of updates and changes in surveillance recommendations and potential late effects [53,54]. Primary care clinicians should consult with the cancer treatment team to ensure evidence-based and well-coordinated care.…”

Intensive follow-up for women with breast cancer: review of clinical, economic and patient’s preference domains through evidence to decision framework

“…Many of the studies included in our review were carried out in previous decades, and their results might be slightly outdated, given the recent substantial changes in breast cancer care [ 52 ]; However, our study also took into account further perspectives, by including also women’s preferences and values, and economic aspects, as adopted in the GRADE approach. The reviews on women’s values and preferences and economic evidence were, however, limited to English and for the last ten years and Medline only, and results would have been more robust if such reviews were carried out with a broader scope.…”

Digital breast tomosynthesis (DBT): recommendations from the Italian College of Breast Radiologists (ICBR) by the Italian Society of Medical Radiology (SIRM) and the Italian Group for Mammography Screening (GISMa)

“…For asymptomatic women with a previous history of breast cancer (included in this general category of women at intermediate risk), we refer to the recommendations provided by the GISMa and the Italian College of Breast Radiologists by SIRM [ 64 ]. The recent observation of a reduction in indeterminate findings in surveillance after breast cancer treatment [ 65 ] plays in favor of DBT usage (LoE D) in this setting, with a preference for sDM/DBT protocols.…”