Optimal Mammography View Sequencing in Women With a History of Breast Cancer Undergoing Surveillance Mammography

Women with a history of breast cancer routinely undergo annual surveillance mammography following breast-conserving surgery and radiotherapy. Standard mammography includes mediolateral oblique (MLO) and craniocaudal (CC) views of each breast. However, there is limited evidence regarding whether the order in which these views are obtained affects patient experience or image quality.

This study randomises 400 women (1:1:1:1) to four different view sequencing protocols:

• Untreated MLO --- Treated MLO --- Untreated CC --- Treated CC
• Untreated CC --- Treated CC --- Untreated MLO --- Treated MLO
• Treated MLO --- Untreated MLO --- Treated CC --- Untreated CC
• Treated CC --- Untreated CC --- Treated MLO --- Untreated MLO

Pain is assessed using a visual analogue scale (VAS) before and after mammography. Patient satisfaction is measured using a post-procedure questionnaire. Image quality will be assessed retrospectively using PGMI scoring by two radiologists. Compression force and breast thickness will also be recorded.

The study uses an intention-to-treat analysis framework.

Inclusion criteria

Female patients aged 18 years or older History of breast cancer treated with breast-conserving surgery (wide local excision) Undergoing first annual surveillance mammogram following completion of surgery and radiotherapy Within five years of breast cancer treatment May have history of whole-breast or partial-breast radiotherapy May have history of axillary surgery Able and willing to provide informed consent

Exclusion criteria

Male patients Patients younger than 18 years History of mastectomy History of bilateral wide local excision Lack of capacity to provide informed consent More than five years since completion of breast cancer treatment