PHILADELPHIA — Women at a high risk of interval second breast cancers might benefit from additional surveillance imaging modalities, according to a new study.

“Annual surveillance mammography is recommended for women with a personal history of breast cancer,” according to a report in the Journal of the National Cancer Institute. “Risk prediction models that estimate mammography failures such as interval second breast cancers could help to tailor surveillance imaging regimens to women’s individual risk profiles.”1.

Past research has suggested that the risk of second primary cancer among survivors at 5, 10, and 15 years is reported to be 3.6%, 8.2%, and 13.9%, respectively.

The University of Pennsylvania Perelman School of Medicine-led study included participation from the Women Veterans Comprehensive Health Center at the San Francisco VA Healthcare System. The study team used LASSO-penalized regression to estimate the probability of an interval second cancer — invasive cancer or ductal carcinoma in situ –in the one-year following a negative surveillance mammogram. The focus was on a cohort of women with a history of breast cancer receiving surveillance mammography in the Breast Cancer Surveillance Consortium in 1996-2019,

“Based on predicted risks from this one-year risk model, we generated cumulative risks of an interval second cancer for the five-year period following each mammogram,’ the researchers explained. “Model performance was evaluated using cross-validation in the overall cohort and within race and ethnicity strata.”

The authors advised that, in 173,290 surveillance mammograms, 496 interval cancers were observed. “One-year risk models were well-calibrated (expected/observed ratio = 1.00) with good accuracy (area under the receiver operating characteristic curve = 0.64),” they wrote. “Model performance was similar across race and ethnicity groups. The median five-year cumulative risk was 1.20% (interquartile range 0.93-1.63%).”

The study noted that median five-year risks were highest in women who were under age 40 or pre- or peri-menopausal at diagnosis and those with estrogen receptor-negative primary breast cancers.

“Our risk model identified women at high risk of interval second breast cancers who may benefit from additional surveillance imaging modalities,” the researchers concluded. “Risk models should be evaluated to determine if risk-guided supplemental surveillance imaging improves early detection and decreases surveillance failures.”

  1. Hubbard RA, Su YR, Bowles EJ, Ichikawa L, et. Al. Predicting five-year interval second breast cancer risk in women with prior breast cancer. J Natl Cancer Inst. 2024 Mar 11:djae063. doi: 10.1093/jnci/djae063. Epub ahead of print. PMID: 38466940.