Breast Disorders
Recommended Reading
Board Questions
A 62-year-old female sees you for a routine health maintenance examination. She has a history of breast cancer diagnosed 6 years ago that was treated with lumpectomy, radiation, and endocrine therapy. She is feeling well today and has no symptoms of concern. There is no family history of breast, ovarian, colon, or prostate cancers.
In addition to mammography, which one of the following annual tests would improve this patient’s chance of survival?
A) No tests
B) CT of the chest
C) MRI of the breast
D) Breast ultrasonography
E) A bone scan
ANSWER: A
Breast cancer, the most common noncutaneous malignancy among women, has a 5-year survival rate of almost 90%, so medical care of such patients is increasingly common. To help provide guidance to primary care physicians, the American Cancer Society and the American Society of Clinical Oncology published their joint Breast Cancer Survivorship Care Guideline in 2016. This guideline includes a recommendation for annual mammography for women with prior treatment for breast cancer to screen for local recurrence or a new primary breast cancer. MRI is not recommended in the absence of specific high-risk criteria such as a BRCA mutation. Similarly, other imaging modalities such as ultrasonography are not recommended in the absence of symptoms. Imaging is not indicated to screen for metastatic disease. Though breast cancer most commonly metastasizes to the lung, bone, and liver, there is no evidence that screening CT or a bone scan provides mortality or quality-of-life benefits.
