Priority 4 from the Post Mastectomy Breast Reconstruction PSP

UNCERTAINTY: How does breast reconstruction surgery impact future surveillance?  (JLA PSP Priority 4)
Overall ranking 4
JLA question ID 0109/4
Explanatory note Breast cancer recurrence after complete mastectomy is very low, however not zero. Our current breast cancer guidelines suggest that routine surveillance of the chest is not necessary following mastectomy since the incidence of breast cancer recurrence is very low. However, prior research has shown that there may be a small group of patients with higher likelihood for breast cancer recurrence in which further surveillance and closer follow-up may be beneficial. Research in this area to stratify patients into groups of high, intermediate, low likelihood for breast cancer recurrence would be important. Furthermore, it would be important to determine the method and frequency of imaging for those patients in the high-risk category for recurrence depending on their previous breast reconstruction method.  
Evidence

Early breast cancer (preventing recurrence and improving survival): adjuvant bisphosphonates: Summary of the evidence on adjuvant bisphosphonates for preventing recurrence or improving survival in people with early breast cancer.

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer. Alberta Health Services - Cancer Care

Breast cancer reconstruction surgery (immediate and delayed) across Ontario: patient indications and appropriate surgical options. Cancer Care Ontario's Program in Evidence-based Care 
Health Research Classification System category Cancer
Extra information provided by this PSP
Original uncertainty examples Impact on screening for local recurrence for high risk disease ~ How do I monitor my long-term reconstructed breast health? What are the chances of recurrence after mastectomy and how can we monitor for that? Are family doctors trained to examine reconstructed breasts?..... ~ what is the impact of the reconstruction to the management of the cancer itself? ~ Does reconstruction alter the effectiveness of future screening/testing? For eg mammograms?  
Submitted by 42 x Patients and Care-givers, 12 x Clinicians 
PSP information
PSP unique ID 0109
PSP name Post Mastectomy Breast Reconstruction
Total number of uncertainties identified by this PSP.

86  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 2 July 2019