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Ductal Carcinoma in Situ (DCIS) - Post Mastectomy

Cancer Care Alberta

The evidence-based recommendations described below outline the standard follow-up procedures for DCIS surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.

Topics

Surveillance Activities & Timelines|Red Flags|Referrals for Recurrence|Concerns|General Support for Healthy Living

Quick Reference

Surveillance Activities & Timelines

Once a patient has been discharged from Cancer Care Alberta, their primary care provider is asked to organize:

  • Diagnostic mammography of intact breast(s) annually. First post-treatment mammogram should be 1 year after diagnostic mammogram (and at least 6 months after radiotherapy).
    • Reconstructed breasts (autologous tissue or implants) or non-reconstructed chest wall post- mastectomy do not require any form of imaging surveillance.
    • Supplemental breast ultrasound can be added to mammography in the setting of extremely dense breast tissue (American College of Radiology category D) and/or at the discretion of the reading radiologist.
  • There is no evidence to support the use of breast self-examination (BSE) as a cancer screening method. To learn more about recognizable signs and symptoms of breast cancer, visit the Screening for Life website.
  • Other routine surveillance investigations (e.g. lab work, tumour markers, diagnostic imaging) are NOT recommended for asymptomatic patients.
  • Regular preventative age-appropriate health screening (i.e., Pap smear, clinical breast examinations, blood sugars) is recommended.

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Red Flags

Be aware of these potential symptoms of DCIS cancer recurrence:

 
Symptoms / Signs Actions / Investigations
New suspicious rash or nodule on chest wall Refer to surgeon for biopsy.
Palpable lymphadenopathy Refer to surgeon for biopsy.
New mass in contralateral breast Mammography +/- ultrasound (+/- biopsy)
 

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Referrals for Recurrence

Patients presenting with any symptoms or signs of recurrence should be investigated and referred back to the treating oncologist. If the oncologist's contact information is not available, search “breast cancer” in the Alberta Referral Directory for the most up-to-date information and instructions for referral. Contact information can also be found in the Provincial Breast Health Referral Pathway.

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Concerns

At any time if you have any concerns or are in need of more information, please call the referring oncologist. We appreciate your partnership in caring for this patient.

Note: The information on this page was adapted from the AHS Guideline Resource Unit's Follow-Up Care for Early-Stage Breast Cancer guideline, and the accompanying DCIS Post-Mastectomy Transfer of Care Physician Letter. Also available is the DCIS Post-Mastectomy Transfer of Care Patient Letter.

View the Breast clinical practice guidelines at Cancer Guidelines.

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