Pattern of follow-up care and early relapse detection in breast cancer patients
- 468 Downloads
Routine breast cancer follow-up aims at detecting second primary breast cancers and loco regional recurrences preclinically. We studied breast cancer follow-up practice and mode of relapse detection during the first 5 years of follow-up to determine the efficiency of the follow-up schedule. The Netherlands Cancer Registry provided data of 6,509 women, operated for invasive non-metastatic breast cancer in 2003–2004. In a random sample including 144 patients, adherence to follow-up guideline recommendations was studied. Mode of relapse detection was studied in 124 patients with a second primary breast cancer and 160 patients with a loco regional recurrence. On average 13 visits were performed during the first 5 years of the follow-up, whereas nine were recommended. With one, two and three medical disciplines involved, the number of visits was 9, 14 and 18, respectively. Seventy-five percent (93/124) of patients with a second primary breast cancer, 42 % (31/74) of patients with a loco regional recurrence after breast conserving surgery and 28 % (24/86) of patients with a loco regional recurrence after mastectomy had no symptoms at detection. To detect one loco regional recurrence or second primary breast cancer preclinically, 1,349 physical examinations versus 262 mammography and/or MRI tests were performed. Follow-up provided by only one discipline may decrease the number of unnecessary follow-up visits. Breast imaging plays a major and physical examination a minor role in the early detection of second primary breast cancers and loco regional recurrences. The yield of physical examination to detect relapses early is low and should therefore be minimised.
KeywordsBreast cancer Mammography Physical examination Relapse Routine follow-up
The authors thank the registrars of the Netherlands Cancer Registry locations Nijmegen, Utrecht, Maastricht and Groningen/Enschede, and the scientific staff and registrars of the Netherlands Cancer Registry for the collection of data. This study was supported by a grant from the Dutch Cancer Society (Grant No. KUN 2008-4086).
Conflicts of interest
The authors declare that they have no conflict of interest.
- 1.Kwaliteitsinstituut voor de Gezondheidszorg CBO, Nationaal Borstkanker Overleg NABON (2002) Richtlijn behandeling mammacarcinoomGoogle Scholar
- 4.Palli D, Russo A, Saieva C, Ciatto S, Rosselli Del Turco M, Distante V, Pacini P (1999) Intensive vs clinical follow-up after treatment of primary breast cancer: 10-year update of a randomized trial. National Research Council Project on Breast Cancer Follow-up. JAMA 281:1586PubMedCrossRefGoogle Scholar
- 9.De Bock GH, Bonnema J, van der Hage J, Kievit J, van de Velde CJ (2004) Effectiveness of routine visits and routine tests in detecting isolated locoregional recurrences after treatment for early-stage invasive breast cancer: a meta-analysis and systematic review. J Clin Oncol 22:4010–4018PubMedCrossRefGoogle Scholar
- 12.Hayes DF (2011) An overview of breast cancer. http://www.uptodate.com. Accessed 9 Nov 2011
- 13.Kwaliteitsinstituut voor de Gezondheidszorg CBO, Nationaal Borstkanker Overleg NABON (2008) MammacarcinomaGoogle Scholar
- 22.Kwaliteitsinstituut voor de Gezondheidszorg CBO Nationaal Borstkanker Overleg NABON (2012) MammacarcinoomGoogle Scholar
- 25.Kimman ML, Dirksen CD, Voogd AC, Falger P, Gijsen BC, Thuring M, Lenssen A, van der Ent F, Verkeyn J, Haekens C, Hupperets P, Nuytinck JK, van Riet Y, Brenninkmeijer SJ, Scheijmans LJ, Kessels A, Lambin P, Boersma LJ (2011) Nurse-led telephone follow-up and an educational group programme after breast cancer treatment: results of a 2 × 2 randomised controlled trial. Eur J Cancer 47:1027–1036PubMedCrossRefGoogle Scholar
- 29.Health Council of the Netherlands (2007) Follow-up in oncology: identify objectives, substantiate actions. Report No. 2007/10. The Hague: Health Council of the NetherlandsGoogle Scholar