American College of Radiology Updates Breast Cancer Screening Appropriateness Criteria

The American College of Radiology (ACR) has released updated appropriateness criteria recommendations for breast cancer screening of women who have had mastectomy or breast reconstruction.

Recurrence rates of breast cancer post-mastectomy are reported to be between 1 percent-to-2 percent. Clinical evaluation is critical for any post-mastectomy symptoms, including the appropriate use of imaging. These are the ACR’s recommendations:

• Imaging is usually not appropriate for a woman who underwent a mastectomy for breast cancer treatment but did not receive reconstruction.

• Mammography or digital breast tomosynthesis (DBT) may be appropriate for breast cancer screening in women with breast cancer history who underwent autologous breast reconstruction with or without implants.

• Imaging is usually not appropriate for women with a breast cancer history who received breast implant reconstruction.

• Imaging usually isn’t appropriate for high-risk women with no breast reconstruction who received a bilateral, prophylactic mastectomy.

• Imaging usually isn’t appropriate for high-risk women with autologous breast reconstruction who underwent a bilateral prophylactic mastectomy.

• Imaging usually isn’t appropriate for high-risk women with breast implant reconstruction who received a bilateral prophylactic mastectomy.

• Breast ultrasound as an initial imaging strategy is usually appropriate for women with a palpable lump or clinically significant pain on the side of a mastectomy that hasn’t had reconstruction.

• Breast ultrasound as an initial imaging strategy is usually appropriate for women with a palpable lump or clinically significant pain on the side of the mastectomy with either autologous or implant reconstruction.