E5038. What’s Next After Saving the Breast? Radiation-Induced Changes and Imaging Considerations Following Breast Conservation Therapy
  1. Anahita Tavana; Mayo Clinic Florida
  2. Neema Patel; Mayo Clinic Florida
  3. Shahrzad Tavana; University Hospitals Cleveland Medical Center, Case Western School of Medicine
  4. Haley Letter; Mayo Clinic Florida
Women with a personal history of breast cancer (PHBC) are at a seven-fold increased risk of developing recurrent disease, compared to women without a prior breast cancer history. Given the high recurrence rate, surveillance imaging plays a crucial role in improving survival among this population.

Educational Goals / Teaching Points
The goal of this exhibit is to review the recommended posttreatment surveillance imaging modalities for patients with a PHBC based on risk factors as well as the expected and concerning imaging changes following breast conservation and radiation therapies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Annual surveillance mammography with or without tomosynthesis is recommended for all women with PHBC. In women with dense breast or age less than 50 at initial breast cancer diagnosis, as well as in those with a greater than 20% lifetime risk for developing breast cancer, supplemental screening with annual MRI is recommended by the American College of Radiology (ACR) as an adjunct to annual mammography. Expected postradiation changes in breast following breast conservation therapy (BCT) include skin thickening, trabecular thickening, and interstitial edema due to engorged lymphatics, as well as fat necrosis, dystrophic calcifications, and glandular atrophy with decreased breast size and background enhancement. Most breast cancer recurrences occur 2–3 years following initial treatment. Any new indeterminate calcifications, asymmetry, mass, or increased skin thickening on mammography or MRI, as well as any new enhancement on breast MRI, are suspicious and warrant biopsy. Radiation changes and complications, however, are not limited to the breast. Extramammary findings following radiation treatment include radiation-induced rib fractures and radiation pneumonitis/fibrosis.

Annual mammography is recommended in all women with a PHBC. Supplemental imaging with MRI should also be considered if certain risk factors are present. Given the relatively high rate of recurrent disease in women with a PHBC, it is imperative to recognize both the expected changes, as well as the concerning features in the breast or extramammary findings on posttreatment surveillance imaging.