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General Surgery
Breast Cancer Surveillance Recommendations

Health New Zealand Bay of Plenty (Te Whatu Ora Hauora a Toi) Recommendations for Breast imaging related to Breast Cancer screening and management

Please note: practice varies from region to region and there are no National guidelines.

Screening imaging (asymptomatic patient) – for those requiring additional screening due to family history

  • Start mammograms 10 years earlier than the youngest affected individual or from 35 years old, whichever comes first. The addition of ultrasound will be at the discretion of the radiologist but may be indicated if there is significantly high breast density.
  • Before the age of 40 years is generally only required for those with an assessment tool confirmed high risk family history – this may require referral to Genetic services or the Breast Clinic to consider the use of annual Breast MRI.
  • From 70 - 80 years old, if the patient remains well, screening mammograms can be reduced to 2 yearly
  • For those over 80 years, continue screening 2 yearly ONLY if physically well and would have treatment for breast cancer.
  • For those with a Family History requiring additional screening – please complete details of affected family member as fully as possible.

Recommendations are based on EviQ guidelines for breast screening for patients with a strong family history. This is a good source for imaging guidelines:

For the high-risk groups (rare, e.g. BRCA 1 and 2) , the EviQ does not specify an upper age limit and for the moderate risk group, it’s 2 yearly from 60 yrs onwards.

Most patients fall into the moderate risk group and tend to over-estimate their family history risk.

In patients with BRCA1 or 2, the lifetime risk approximates the population risk once the person is 60 yrs and beyond.

Screening age limits and frequency is about remaining lifetime risk, effectiveness and cost, balanced by patient harm, anxiety and false positive results.

Surveillance imaging - routine regular imaging post cancer treatment

  • Whilst the patient is being followed up in breast clinic the imaging will be organised through the breast clinic. (The duration of follow up may vary from 2 to 5 years)
  • Once discharged from breast clinic, if the patient is aged between 45 and 69 years the patient will require alternating annual mammography between Breastscreen Aotearoa (BSA) and the PHO Community Breast screen service. Once outside BSA age range (70+yrs), then please continue to arrange mammography through the PHO Coordinated Community Breast Screen service
  • Annual Mammograms should continue until the patient is at least 70 yrs and 10 years post diagnosis
  • From 70 - 80 years old, if the patient remains well and is at least 10 years post diagnosis, screening mammograms can be reduced to 2 yearly
  • For those over 80 years, continue screening 2 yearly ONLY if physically well and would have treatment for breast cancer.
  • For those with a History of Breast cancer – please include year of Diagnosis and last mammogram date (and report if available)
  • Patients who have had bilateral total mastectomy (with or without reconstruction) as prophylaxis against or treatment for breast cancer do not require ongoing mammogram and/or ultrasound.

Diagnostic Imaging – Patient of any age presenting with symptoms

  • For patients 35 yrs and above with presenting symptoms, please request “Diagnostic Mammogram and Ultrasound”. Please provide details of the clinical presentation e.g. site of lump
  • For patients under 35 yrs, please request “Diagnostic Ultrasound +/- Mammogram if required”. Patients requiring imaging who are under 35 yrs may be offered USS in the first instance. Mammograms may be arranged at the radiologist’s discretion if they feel it is needed.
  • For all referrals to the PHO Coordinated Community Breast Screen Service please ensure as much relevant information as possible is included in the referral, including dates and copies of previous imaging if available

The BPAC e-referral will be updated shortly to reflect this guidance.

Please note: The PHO Coordinated Community Breast Screen service is unable to manage referrals relating to breast implant issues (unless there is a cancer concern) or those who do not need to continue screening beyond the age of 70 but would like to. For breast implant issues requiring imaging where the patient is unable to self-fund please contact the Radiology service at Health New Zealand to discuss.

Disclaimer: These pathways, for the care and management of patients within Bay of Plenty, have been developed jointly by primary and secondary care clinicians. They provide guidance for General Practice teams to diagnose and manage patients suffering from a number of different conditions, and contain patient information resources. The pathways are maps of publicly-funded services accessed by referral from the community, and are strongly evidence based, but are not full clinical guidelines. As the pathways are suggested guidance only, while using them you must exercise your own clinical judgement and pertinent clinical data when treating your patient. This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.