The present study was designed to investigate whether there are any characteristics of breast cancer patients or their initial tumors that might be useful for customizing follow-up surveillance recommendations. The authors followed 17,286 women for up to five years after they had received an initial diagnosis of either ductal carcinoma in situ (DCIS) or early stage (I/II) invasive breast cancer. The women were diagnosed during the period 1996 to 2006. Rates of recurrences and second primary breast tumors were calculated, examining demographic factors, breast cancer risk factors, and characteristics of the initial diagnosis (stage, type of treatment, mode of diagnosis) as possible predictive factors. Nearly 4% of the study population had either a breast cancer recurrence (314 women) or a new primary breast tumor (344). Women who used adjuvant hormonal therapy or were at least 80 years old had the lowest rates of second breast cancer events.

Women who had initially been diagnosed with DCIS or stage IIB invasive breast cancer or estrogen/progesterone receptor-negative (ER-/PR-) tumors and women under 50 at diagnosis were found to have elevated recurrence and second primary tumor rates. Women who had a lumpectomy without radiation had higher recurrence rates and women with a family history of breast cancer or dense breasts had higher second primary tumor rates. Over one-third of the recurrences (37.6%) and second primary tumors (36.3%) were not detected during routine follow-up screening (primarily mammograms). Among this group, the recurrences or new tumors were accompanied by symptoms and detected by the women themselves between screening visits. The authors conclude that a recent negative mammogram should not falsely reassure physicians or women with new breast symptoms or changes. In addition, the study did not provide any evidence in support of changing surveillance intervals for different subgroups of breast cancer survivors.