Evaluation of surveillance mammography following reconstructive breast surgery

Abstract

Objective. There are currently no recommendations on the use of surveillance mammography for women who have undergone breast reconstruction following mastectomy. The objective of this study is to address the needs of this population of women with regards to the inclusion of ipsilateral surveillance mammography in their regular surveillance. Methods. A multimethod approach including (1) a systematic review, (2) a population based cohort study, and (3) an economic analysis was conducted to evaluate this issue. Results. The systematic review found only case reports and case series' addressing the role of surveillance mammography in women who have undergone breast reconstruction following mastectomy. These studies documented that local recurrence does occur in reconstructed breasts, and that these may be detected by surveillance mammography. In the cohort component of the study, variation in practice was found as 39% of women in the cohort underwent at least one surveillance mammogram of their reconstructed breast. Inference on the effectiveness of surveillance mammography of the reconstructed breast could not be made. The economic analysis found that in order to be cost effective, a reduction in metastatic risk of 3.34% following local recurrence detected by surveillance mammography was required. Conclusion. The findings from this thesis point to two recommendations. First, until stronger evidence becomes available, it is prudent to recommend that women with breast reconstruction undergo yearly bilateral surveillance mammography. Second, future research is required to review patient outcomes and provide the needed clinical evidence to support this practice.