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Mastectomy follow-up by biennial mammograms: is it worthwhile?

The value of follow-up after mastectomy for breast cancer is controversial. One reason is to detect metachronous tumour in the contralateral breast, but the optimum method for achieving this is undecided. The long-term follow-up policy of our unit is annual clinical review combined with biennial mammography. We have assessed the benefit of this policy in the detection of tumours of the contralateral breast. The case notes of 216 patients undergoing mastectomy between 1978 and 1985, under the care of one consultant surgeon (DJTW) were reviewed. Follow-up was complete to December 1997, thus allowing a minimum follow-up of 12 years. The development of a metachronous tumour was recorded as was its method of detection : either clinically, by the patient or the clinician, or by routine mammography. Two-hundred and five patients were available for follow-up of the contralateral breast. Seventeen (8.3%) developed metachronous tumours. Eight were detected by the patient, 4 by the clinician and 5 by routine follow-up mammography. Biennial mammography does not appear to be beneficial in breast cancer follow-up. More work is required to determine the benefits of more frequent mammography, with or without breast self-examination and clinical review within the hospital environment or within primary care.