Breast Cancer Research and Treatment

, Volume 136, Issue 3, pp 859–868 | Cite as

Pattern of follow-up care and early relapse detection in breast cancer patients

  • Sandra M. E. Geurts
  • Femmie de Vegt
  • Sabine Siesling
  • Karin Flobbe
  • Katja K. H. Aben
  • Margriet van der Heiden-van der Loo
  • André L. M. Verbeek
  • Jos A. A. M. van Dijck
  • Vivianne C. G. Tjan-Heijnen


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.


Breast 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.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Sandra M. E. Geurts
    • 1
  • Femmie de Vegt
    • 1
  • Sabine Siesling
    • 2
    • 3
  • Karin Flobbe
    • 2
  • Katja K. H. Aben
    • 1
    • 2
  • Margriet van der Heiden-van der Loo
    • 2
  • André L. M. Verbeek
    • 1
  • Jos A. A. M. van Dijck
    • 1
  • Vivianne C. G. Tjan-Heijnen
    • 4
  1. 1.Department of Epidemiology, Biostatistics and HTARadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Comprehensive Cancer Centre the NetherlandsUtrechtThe Netherlands
  3. 3.Health Technology and Services ResearchTwente UniversityEnschedeThe Netherlands
  4. 4.Department of Internal Medicine, GROW – School for Oncology and Developmental Biology, Division of Medical OncologyMaastricht University Medical CentreMaastrichtThe Netherlands

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