Subsequent breast cancer

SUBSEQUENT BREAST CANCER

Evidence-based recommendation for subsequent breast cancer (IGHG^a)
This page is part of the PanCare Follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Read this guideline in PLAIN language for survivors

Who is at risk for subsequent breast cancer?

Female CAYA cancer survivors treated with

radiotherapy ≥ 10 Gy to a volume exposing the breasts^b
high abdominal field radiation above the diaphragm at a young age ^c
≥200 mg/m2 doxorubicin ^d

What surveillance modality should be used and at what frequency should it be performed?

Physical examination of the breasts ^e
Mammography
Breast MRI

	Radiotherapy to a volume exposing the breasts^b
Doxorubicin	0-9 Gy chest radiation	≥10 Gy chest radiation or upper abdominal field radiation exposing breast tissue^c
0-199 mg/m² doxorubicin	–	Mammogram and MRI Every year Starting at age 25 years or ≥ 8 years from radiation, whichever occurs last
≥200 mg/m² doxorubicin	Because this is a moderate-strength recommendation, decisions should be individualized:^c Mammogram or MRI* Starting at age 30 years or ≥8 years from exposure, whichever occurs last**	Mammogram and MRI Every year Starting at age 25 years or ≥ 8 years from radiation, whichever occurs last

* The use of mammography is recommended; breast MRI can be considered according to the national or local breast cancer screening guidelines for moderate-risk individuals
** Frequency and continuation of breast cancer surveillance should adhere to national or local breast cancer screening guidelines for

What should be done if abnormalities are identified?

Refer to the appropriate HCP

Disclaimer

While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

PanCareFollowUp has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 824982. The material presented and views expressed here are the responsibility of the author(s) only. The EU Commission takes no responsibility for any use made of the information set out.

^a This recommendation reflects the recommendations of the IGHG Breast cancer guideline (Updated breast cancer surveillance recommendations
for female childhood, adolescent and young adult cancer survivors from the International Guideline Harmonization Group, Journal of Clinical Oncology, 2020; and International Guideline Harmonization Group recommendations for breast cancer surveillance in childhood, adolescent and young adult cancer survivors after anthracyclines, JCO Oncology Practice, 2025; accessible through https://www.ighg.org/guidelines/topics/breast-cancer/).

^b Radiotherapy dose estimations based on the mean dose received to the breasts is preferred over the prescribed dose since the latter may not reflect radiation exposure to the breasts as accurately.

^c For survivors treated with upper abdominal field radiation that can extend above the diaphragm likely exposing breast tissue at a young age or ≥200 mg/m2 doxorubicin, the surveillance decision should be an individual one, taking into account other contributing factors (patient age, family history, menopausal status, other previous cancer treatment, treatment era) and personal values regarding the potential advantages and disadvantages of surveillance (see Survivor Information Form in Appendix E in the recommendations).

^d No recommendation can be formulated for routine breast cancer surveillance for childhood, adolescent and young adult cancer survivors treated with other types of anthracyclines, i.e. daunorubicin, epirubicin or idarubicin, in the absence of chest radiation, because there is currently inconclusive evidence. Because the evidence suggests that survivors treated with ≥200 mg/m2 doxorubicin in the absence of chest radiation have a moderately increased breast cancer risk, the decision to undertake breast cancer surveillance for CAYA cancer survivors treated with daunorubicin, epirubicin or idarubicin should be made by the survivor and healthcare provider after careful consideration of the potential harms and benefits of breast cancer surveillance and considering other contributing factors (see Survivor Information Form).

^e Clinical breast exam for female survivors at risk who are returning for follow-up medical evaluations in countries where breast cancer surveillance access is through clinical referral.