Periodic follow-up after breast cancer and the effect on survival

Eur J Surg. 2001 Jul;167(7):490-6. doi: 10.1080/110241501316914849.

Abstract

Objective: To assess the role of routine follow-up in current management of breast cancer.

Design: Retrospective review.

Setting: Teaching hospital, The Netherlands.

Subjects: 270 patients who presented with recurrent breast cancer, 1974-90.

Main outcome measure: Recurrence was coded as asymptomatic or symptomatic and related to survival.

Results: 170 (63%) of the recurrences were detected when they were symptomatic and 100 (37%) when they were not. The groups differed significantly according to the site of recurrence; 45/100 recurrences were local in the asymptomatic group compared with 23/170 (14%) in the symptomatic group. There was no significant difference in disease-free survival between the two groups. Overall 5-year survival after primary treatment for all recurrences (locoregional and distant) was significantly better (p=0.0003) in the asymptomatic group (62/100) than in the symptomatic group 79/170 (46%). However, when locoregional and distant recurrences were analysed separately no significant differences were found between both groups in overall survival after primary treatment or survival after detection of recurrence. The 5-year overall survival after primary treatment for distant recurrence was 26/47 (55%) in the asymptomatic group compared with 62/134 (46%) in the symptomatic group (p=0.13). For locoregional recurrence these figures were 35/45 (78%) and 14/23 (61%), respectively (p=0.34). Routine follow-up hardly affected the course of locoregional recurrence. Only five of 75 patients with local recurrence (7%) developed uncontrolled local disease, 2 of whom were initially detected during routine follow-up.

Conclusions: We conclude that in the current management of breast cancer the medical impact of follow-up is low, so follow-up visits after treatment for breast cancer are hardly warranted.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Hormonal / metabolism
  • Breast Neoplasms / mortality*
  • Continuity of Patient Care*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality*
  • Netherlands / epidemiology
  • Nitric Oxide / metabolism
  • Retrospective Studies
  • Survival Analysis
  • Tamoxifen / pharmacology
  • omega-N-Methylarginine / pharmacology

Substances

  • Antineoplastic Agents, Hormonal
  • Tamoxifen
  • omega-N-Methylarginine
  • Nitric Oxide