The value of mammography vs. physical examination in detecting a recurrent breast cancer in women with a previous diagnosis of breast cancer.

Abstract

Abstract Abstract #5014 Background: The value of mammography in detecting early breast cancer has been firmly established, however the benefit of mammography in detecting recurrent breast cancer has not been clearly elucidated. The purpose of this study is to determine the value of mammography versus physical examination in detecting a recurrent breast cancer in women with a previous diagnosis of breast cancer.
 Methods: This is an IRB approved retrospective chart review. Fifty-eight patients were identified from our institution's Breast Center tumor registry who were diagnosed with stage I-II breast cancer from 1973-2006 and who subsequently developed a locoregional recurrence. The method of detection of the initial breast cancer was recorded and compared to the method of detection of the recurrent breast cancer.
 Results: The mean age at the original diagnosis was 47 years (range 29-89 years). The mean time to recurrent breast cancer or second primary was 38 months (range 6-173 months). Seventeen patients (29%) were initially diagnosed with breast cancer by screening mammography. Of those 17, 3 (18%) were diagnosed with a recurrent breast cancer by mammography, and the remaining 14 by physical exam. Among the 14 patients that presented initially with a palpable breast mass and positive mammogram, 3 (21%) had recurrent breast cancer detected by mammography. Thirty-four patients (59%) initially presented with a palpable mass. Nineteen of these patients had mammograms, 5 did not have mammography, and 8 were unknown whether imaging was done. Of those 19 that had mammography, 14 were positive and 5 were negative. The 5 patients with palpable masses and negative mammograms all had mastectomies initially and their locoregional recurrence was detected by physical exam. Forty-nine patients (84%) had a clinical finding leading to the diagnosis of recurrent breast cancer and seven (12%) had recurrence identified by mammography. Two patients had unknown method of detection of recurrence. The clinical recurrences were identified in the axilla (53.4%), chest wall (12%), supraclavicular fossa (8.6%), breast (3.4%), and skin (3.4%).
 Conclusions: One-third of patients with a recurrent breast cancer had their initial cancer identified by mammography but only 12% had their recurrence identified by mammography. Fifty-nine percent of patients were initially diagnosed by physical examination and 84% of recurrence was diagnosed with physical examination. Patients whose initial cancer was visible on mammogram are likely to have a recurrence also visible on mammogram. Though mammography is useful in detecting the first early stage breast cancer, most patients present with a clinical finding when they present with the recurrent breast cancer. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5014.