Breast Cancer – Care to Care's Clinical Criteria

Routine Imaging Guidelines

In Situ carcinoma

Ductal carcinoma in Situ DCIS

After surgery Mammogram every 12 months, after radiation mammogram every 6 – 12 months.

PET is not recommended

MRI Breast

Lobular Carcinoma in Situ LCIS

Mammogram every 6 – 12 months. PET is not recommended

Invasive Carcinoma

Inflammatory Breast Cancer

Breast MRI

CT chest, Abdomen and Pelvis

Recurrent Phylloides tumor Chest CT

Stage I, IIA, IIB IIIA all M0 (See Breast Cancer Staging Below)

Initial Evaluation and Staging

Breast MRI

Bone scan if Alkaline Phosphatase is elevated or there are bone symptoms

CT of chest for symptoms or findings in chest

CT or MRI of abdomen and pelvis if

abdominal symptoms or findings on physical examination

abnormal liver functions

elevated alkaline phosphatase

Routine Surveillance

No routine studies have been recommended by ASCO or NCCN, studies should be approved for adequate clinical cause.

Stage IIIA, IIIB and IIIC all M0 (See Breast Cancer Staging Below)

Initial Evaluation

Breast MRI

Bone scan if Alkaline Phosphatase is elevated or there are bone symptoms

CT of chest for symptoms or findings in chest

CT or MRI of abdomen and pelvis

PET/CT

Routine Surveillance

No routine studies have been recommended by ASCO or NCCN, studies should be approved for adequate clinical cause.

Stage IV and Recurrent Disease (See Breast Cancer Staging Below)

Surveillance for Recurrence, and for any Stage IV

Bone scan

CT or MRI abdomen

CXR

Mammogram yearly

PET/CT if other studies are equivocal. (See NCCN Breast Guidelines, V2,2012 p BINV-14)

References

NCCN Clinical Practice Guidelines in Breast Cancer V.2.2012 accessed 7/22/11

NCCN Clinical Practice Guidelines in Breast Cancer V.2.2010 accessed 8/11/10

NCCN Clinical Practice Guidelines in Breast Cancer V.1.2009 accessed 1/20/09

H. J. M. Jacobs , J. A. A. M. van Dijck , E. M. H. A. de Kleijn , L. A. L. M. Kiemeney , and A. L. M. Verbeek Routine follow-up examinations in breast cancer patients have minimal impact on life expectancy: A simulation study Ann Oncol 12: 1107-1113.

Khatcheressian, James L., Wolff, Antonio C., Smith, Thomas J., Grunfeld, Eva, Muss, Hyman B., Vogel, Victor G., Halberg, Francine, Somerfield, Mark R., Davidson, Nancy E. American Society of Clinical Oncology 2006 Update of the Breast Cancer Follow-Up and Management Guidelines in the Adjuvant Setting J Clin Oncol 2006 24: 5091-5097

Breast Cancer Surveillance Guidelines Thomas J. Smith Journal of Onclogy Practice Jan 1, 2013:65-67.

Spick, Claudio, et al. “Rate of malignancy in MRI-detected probably benign (BI-RADS 3) lesions.” American Journal of Roentgenology 202.3 (2014): 684-689.

After surgery Mammogram every 12 months, after radiation mammogram every 6 – 12 months.

PET is not recommended

MRI Breast

Mammogram every 6 – 12 months. PET is not recommended

Breast MRI

CT chest, Abdomen and Pelvis

Recurrent Phylloides tumor Chest CT

Breast MRI

Bone scan if Alkaline Phosphatase is elevated or there are bone symptoms

CT of chest for symptoms or findings in chest

abdominal symptoms or findings on physical examination

abnormal liver functions

elevated alkaline phosphatase

No routine studies have been recommended by ASCO or NCCN, studies should be approved for adequate clinical cause.

Breast MRI

Bone scan if Alkaline Phosphatase is elevated or there are bone symptoms

CT of chest for symptoms or findings in chest

CT or MRI of abdomen and pelvis

PET/CT

No routine studies have been recommended by ASCO or NCCN, studies should be approved for adequate clinical cause.

Bone scan

CT or MRI abdomen

CXR

Mammogram yearly

PET/CT if other studies are equivocal. (See NCCN Breast Guidelines, V2,2012 p BINV-14)

NCCN Clinical Practice Guidelines in Breast Cancer V.2.2012 accessed 7/22/11

NCCN Clinical Practice Guidelines in Breast Cancer V.2.2010 accessed 8/11/10

NCCN Clinical Practice Guidelines in Breast Cancer V.1.2009 accessed 1/20/09

H. J. M. Jacobs , J. A. A. M. van Dijck , E. M. H. A. de Kleijn , L. A. L. M. Kiemeney , and A. L. M. Verbeek Routine follow-up examinations in breast cancer patients have minimal impact on life expectancy: A simulation study Ann Oncol 12: 1107-1113.

Breast Cancer Surveillance Guidelines Thomas J. Smith Journal of Onclogy Practice Jan 1, 2013:65-67.

Spick, Claudio, et al. “Rate of malignancy in MRI-detected probably benign (BI-RADS 3) lesions.” American Journal of Roentgenology 202.3 (2014): 684-689.

Tis, N0, M0

T1, N0, M0

T0, N1, M0

T1, N1, M0

T2, N0, M0

T2, N1, M0

T2, N0, M0

T0, N2, M0

T1, N2, M0

T2, N2, M0

T3, N2, M0

T4, N0, M0

T4, N1, M0

T4, N2, M0

Stage IIIC T any, N3, M0

Stage IV T any, N any, M1