Women who have undergone a double mastectomy to treat ductal carcinoma in situ (DCIS), a noninvasive form of breast cancer also known as stage 0 breast cancer, may not benefit from routine mammograms or other breast imaging after surgery, according to a new study led by investigators at the UCLA Health Jonsson Comprehensive Cancer Center.
The study, published in Surgical Oncology Insight, found that most cancer recurrences were detected after patients developed symptoms or doctors noticed concerning changes, rather than through routine screening. The findings suggest that routine imaging may offer limited benefit for women who have no symptoms after double mastectomy.
“Our findings raise an important question about the value of continued screening after cancer treatment for women with DCIS,” said Dr. Nimmi Kapoor, associate professor of surgery at the David Geffen School of Medicine at UCLA and senior author of the study. “This highlights the importance of appropriate clinical follow-up and making sure patients and their physicians know what changes to look for.”
DCIS is a noninvasive form of breast cancer in which abnormal cells develop inside the milk ducts but have not spread into surrounding breast tissue. It is typically treated with surgery, either by removing the affected tissue or the entire breast. Although outcomes are generally excellent, an increasing number of women with DCIS are choosing to have both breasts removed, even when cancer is found in only one breast, despite a lack of evidence that the more extensive surgery improves survival.
After a double mastectomy, very little breast tissue remains, making the benefit of continued routine breast imaging uncertain. Unlike women who undergo breast-conserving surgery, who generally continue receiving mammograms to monitor remaining breast tissue, women who have both breasts removed have a very low risk of recurrence. However, recommendations for imaging after mastectomy vary among medical organizations, creating uncertainty about what follow-up care is necessary.
To better understand how breast imaging is used after double mastectomy, the UCLA team reviewed the medical records of 90 patients who underwent bilateral mastectomy for DCIS between 2017 and 2019. Researchers examined how often patients received mammograms, ultrasounds or MRIs after surgery, why the tests were ordered and whether they led to biopsies or cancer diagnoses. Patients were followed for a median of nearly six years.
The researchers found that half of the patients continued to receive breast imaging after surgery, undergoing a total of 154 imaging examinations. Of those tests, 12 led to biopsies in nine patients. Eight biopsy findings were benign, while four revealed cancer recurrences.
Of those four recurrences, just one was detected through routine screening in a patient without symptoms. The other three were identified after patients developed symptoms or doctors noticed concerning changes, including lumps, swelling or breast pain, that prompted diagnostic imaging.
The researchers also found no consistent relationship between imaging use and patient characteristics such as age, genetic risk, tumor size or type of breast reconstruction. This suggests that screening decisions may vary among physicians rather than being consistently guided by a patient's individual risk factors.
Primary care and OB-GYN physicians also accounted for nearly half of all imaging orders and 60% of routine screening examinations, highlighting a potential need for greater education about appropriate follow-up care after mastectomy.
The findings also raise concerns about unnecessary imaging, which can lead to false-positive results, additional biopsies, medical costs and anxiety for patients without substantially improving cancer detection.
The researchers emphasized that the findings do not mean patients should stop receiving follow-up care. Regular clinical evaluations and prompt investigation of new lumps, skin changes, swelling or other concerning symptoms remain important. Imaging may also be necessary for other reasons, such as evaluating breast implants after reconstruction, which is different from screening for cancer recurrence.
Because the study involved a relatively small number of patients at a single medical center, the researchers said larger studies are needed to determine whether certain patients at higher risk of recurrence, including those with inherited genetic mutations or more extensive disease, might benefit from more targeted screening.
“One of the important takeaways is that we need more consistent guidance about what follow-up care should look like after double mastectomy," said Kapoor. “By helping physicians better understand when imaging is necessary, we can reduce unnecessary testing while ensuring patients continue to receive the care that's most appropriate for them.”
Other study authors from UCLA include Jessica Kieu, Yashila Suresh, Kaden Hong, Jiyoon Kim, Danielle Graham, Jennifer Baker and Mediget Teshome.
