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Long-term follow-up of early-stage breast cancer patients treated by breast-conserving surgery should be based on mammography The recommendations for follow up after breast cancer are inconsistent from country to country, largely as a result of inadequate evidence on which to base recommendations. Our data highlight a number of important issues. Among 1312 women treated with breast conserving surgery for early stage breast cancer and followed for a median of ten years, potentially treatable relapse after occured at a constant rate of 1 - 1.5% for at least ten years with no early peak in incidence. If routine follow up is to be provided after breast cancer, then it must continue for at least ten years in some form. However, clinical examination detected only 13% of potentially treatable relapses, as compared with 51% mammographically and 35% patient detected. Moreover, ipsilateral breast relapse detected by clinical examination is associated with a significantly poorer survival than such relapse detected by mammography or patient self-examination. It may be then that routine clinical examination is unnecessary. In contrast, mammography is of central importance to the detection of treatable relapse. The yield when undertaken annually is 5.37 relapses detected for every 1000 mammograms performed, at least equivalent to the yield seen under a three yearly protocol in the general screening population in the UK. This justifies the use of annual mammography in this patient population. Given the rising incidence of new contralateral cancers seen after ten years in several studies, there may be justification for continuing to provide annual mammography indefinitely. As routine clinic visits are poor at addressing the other aims of follow up, it may be more appropriate to ensure that a good educational and self awareness programme is in place with easy access to specialist care for patients with problems. Ideally, a remote screening tool to assess psychological well being and adverse effects of treatment would be introduced which would allow those who have problems to be detected and brought back to clinic. Much less frequent clinic visits could be planned to coincide with changes in adjuvant hormone therapy. This more focussed approach would benefit the patient and be more “cost effective".
Bibliographic reference:
David Montgomery University Department of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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