E1247. Breast Cancer Recurrence Status Post Mastectomy: The Ghosts of Breast Cancer Past
  1. Janki Patel; Mount Sinai Hospital
  2. Rayane Issa; Mount Sinai Hospital
  3. Janet Szabo; Mount Sinai Hospital
  4. Laurie Margolies; Mount Sinai Hospital
Breast cancer may reoccur after total mastectomy and remission. Recurrence is defined as cancer that occurs after treatment and remission (no evidence of disease) are achieved. There are several types of recurrence. Local recurrence is cancer that returns in the same breast or chest area as the original tumor. Regional recurrence is cancer that returns near the original tumor in axillary lymph nodes. Distant recurrence is cancer that spreads away from the original tumor to involve the lungs, bones, brain, or other body parts, referred to as stage 4 breast cancer. Development of cancer in the opposite, untreated breast (but nowhere else in the body) is a new breast cancer diagnosis, and not the same as recurrence. Approximately 30% of women diagnosed with ductal carcinoma in situ (DCIS) are treated by mastectomy. There is 5.9% chance of locoregional recurrence of DCIS within five years after skin sparing mastectomy and 0-1% chance of loco-regional recurrence after simple mastectomy. There are various reasons for recurrence such as close or involved margins, distant spread of tumor prior to surgery, under-treatment, young age, and other currently unknown reasons. Breast cancer recurrence can be more difficult to treat. The same therapy may not be effective again as tumors develop a tolerance to certain treatments, such as chemotherapy. If cancer develops in a reconstructed breast, the surgeon may remove the breast implant/skin flap. Treatments for recurrence may include chemotherapy, hormone therapy such as tamoxifen, immunotherapy, radiation therapy, and targeted therapy.

Educational Goals / Teaching Points
The educational goal is to review the definition of breast cancer recurrence and types of recurrence. In addition, risk factors or causes of recurrence after mastectomy and available treatment options after recurrence will be discussed. The objective is to provide a literature review of the recurrence of breast cancer status post mastectomy and demonstrate multiple case-based examples utilizing different imaging modalities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Various imaging modalities including ultrasound, mammography, magnetic resonance imaging, and fluorodeoxyglucose (FDG)-positron emission tomography (PET) will be utilized to portray the reoccurrence of breast cancer after mastectomy and remission. These will help demonstrate the importance of follow up imaging even after remission is achieved.

Breast cancer can unfortunately reoccur even after total mastectomy and remission. Although the reported incidence after simple mastectomy is less than skin sparing mastectomy, reoccurrence is still a dreaded possibility. There are various reasons for reoccurrence such as unclear surgical margins, distant spread of tumor prior to surgery, under-treatment, and young age at the time of diagnosis allowing more lifetime for reoccurrence. Other reasons may just involve poor luck or be unknown to the breast community at this time. Regardless, it is essential to have follow up imaging (screening) even after treatment. Reoccurrence of breast cancer is even more difficult to treat and therefore, early detection is ideal.