Routine breast imaging after double mastectomy for DCIS may do more harm than good

Rethinking routine screening after double mastectomy

A new UCLA-led study published in Surgical Oncology Insight is challenging the practice of routine breast imaging for women who've had a double mastectomy to treat ductal carcinoma in situ (DCIS) — a noninvasive, stage 0 form of breast cancer. Researchers reviewed records of 90 patients over nearly six years and found that most cancer recurrences were caught through symptoms, not scheduled scans.

Despite very little remaining breast tissue after surgery, half of patients still received imaging post-mastectomy. Of 154 imaging exams performed, only one cancer recurrence was detected through routine screening in an asymptomatic patient. The rest were flagged after patients or doctors noticed lumps, swelling, or other changes.

Key Takeaways:

• Routine imaging led to 12 biopsies in 9 patients — 8 were benign, raising concerns about unnecessary procedures and patient anxiety
• Primary care and OB-GYN physicians ordered nearly half of all imaging and 60% of routine screenings, pointing to a need for clearer post-mastectomy guidelines
• Imaging may still be warranted for implant evaluation or symptomatic patients, but not as blanket cancer surveillance

Why it matters: With no consistent national guidance on post-mastectomy imaging, patients may be over-screened without meaningful benefit. This study calls for standardized protocols to reduce unnecessary testing while keeping patients safe.