In addition to the physical examination, the patient should undergo annual mammography to be completed 1 year from the previous screening mammogram. For patients treated with breast-conserving therapy, initial postradiation mammograms are generally performed 6 months after the completion of treatment, with subsequent annual mammograms performed 12 months from the previous screening exam.17 Despite clear and consistent guidelines about the use of surveillance breast imaging, several studies have demonstrated underuse of mammography among survivors of breast cancer.6,19 For example, in one study, only 61.9% of women with stages I or II disease received mammography in the first year of follow up.6 In another study of patients in the combined Surveillance, Epidemiology, and End Results–Medicare data set, only 56.7% had mammography yearly over a 3-year period. Nonclinical factors, such as black race and being unmarried, have been associated with underuse of surveillance mammography,6,19 suggesting that high-quality surveillance care is not applied equally to all women.
Magnetic resonance imaging (MRI) should be offered to women who are at particularly high risk of a second primary breast cancer, such as women with an inherited susceptibility to breast cancer by virtue of having a BRCA1 or BRCA2 mutation. The role of surveillance MRI in women not deemed to be at high risk of a second primary cancer has not been established.