Breast cancer surveillance: nothing has changed in the past decades (?)

Abstract

In the well-developed countries, breast cancer-related mortality rates show decreasing tendency. Relapse occurs only in about one-fourth of all patients. According to randomized studies, no survival benefit is provided in these cases by practising intensive follow-up including instrumental studies to actively search for distant metastases. The most important role of patient surveillance is to detect early-stage, potentially curable isolated local/regional relapses or second primary breast cancers. More and more attention is given to the early detection and treatment of the side-effects of the therapy on the other hand. Even a “minimalist” follow-up practice maintains the relationship with the patient that is important for getting reassurance for compliance with adjuvant endocrine therapies, assistance in case of symptoms of metastasis, or if medical or social decisions are to be made. Sometimes psychological problems occur, which necesitate special support. In routine practice, regular visits including patient history, physical examination, and breast imaging studies on a 6–12 monthly basis for up to 5 years and yearly thereafter with the maintenance of a supportive relationship with the patient are recommended. Chest, abdominal or bone imaging studies, laboratory or tumor marker tests are justified only in suspicion of relapse.