ESR Essentials: post-treatment breast cancer surveillance from mammography to a more personalised approach-practice recommendations by the European Society of Breast Imaging.

The breast cancer long-term survival rate has improved; early detection of local recurrence and second primary cancers has been crucial to this success. Mammography is the standard imaging technique for follow-up, but its sensitivity is affected by breast density and post-treatment changes. This article discusses the role of mammography in the follow-up of women after breast cancer treatment, and the use of additional imaging techniques. For patients with genetic mutations or a risk of breast cancer above 20%, high-risk screening protocols are necessary. Non-genetic mutation carriers may require supplemental imaging. Contrast imaging should be offered to women with dense breasts and a young age at diagnosis. While MRI remains the most sensitive tool, it has limitations, and contrast-enhanced mammography (CEM) emerges as a more affordable alternative. Current standards dictate the use of post-operative mammography annual surveillance for at least 5 years. As surveillance strategies evolve, the importance of personalised follow-up based on individual risk factors is emphasised. In fact, there is a need to optimise surveillance protocols and ensure equitable access to appropriate imaging methods for all breast cancer survivors. These recommendations can be implemented into practice by evaluating individual risk factors and engaging patients in shared decision-making. KEY POINTS: Adequate knowledge of normal post-surgical changes of the breast is crucial for avoiding unnecessary work-up. Five-year annual two-view mammography is the standard test for surveillance follow-up. Surveillance follow-up should move beyond a "one size fits all" to a more personalised approach.