Connect
MJA
MJA

Early detection of breast cancer the second time around: mammography in women with a personal history of breast cancer

Nehmat Houssami and Diana L Miglioretti
Med J Aust 2011; 194 (9): . || doi: 10.5694/j.1326-5377.2011.tb03054.x
Published online: 2 May 2011

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


  • 1 Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW.
  • 2 Biostatistics Unit, Group Health Research Institute, Seattle, Wash, USA.
  • 3 Department of Biostatistics, University of Washington, Seattle, Wash, USA.


Correspondence: nehmath@med.usyd.edu.au

Acknowledgements: 

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.

Competing interests:

We had prominent roles in the design, conduct and publication of the study discussed in this editorial.9

  • 1. Buist DS, Abraham LA, Barlow WE, et al. Diagnosis of second breast cancer events after initial diagnosis of early stage breast cancer. Breast Cancer Res Treat 2010; 124: 863-873. Epub 2010; Aug 11.
  • 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.
  • 3. Lash TL, Fox MP, Buist DS, et al. Mammography surveillance and mortality in older breast cancer survivors. J Clin Oncol 2007; 25: 3001-3006.
  • 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).

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.