ABSTRACT: Outpatient Follow-up After Treatment for Early Breast
Cancer: Updated Results After 5 Years
Abstract: The value of frequent outpatient follow-up in the first
few years after primary treatment for early breast cancer is
a controversial issue. Schedules involving 3-4 monthly visits
in the first 2-3 years and 6-monthly from years 3-5 are still
In this study we audited such a policy from a single
cancer centre, identifying a cohort of all 612 patients with
early breast cancer (pT1-3pN0-1NXM0) referred for adjuvant therapy
The hospital records were reviewed to ascertain patient and tumour
characteristics, the surgical and adjuvant treatment received,
the timing and sequencing of recurrences and their mode of detection.
Five hundred and five patients had breast conservation surgery.
The actuarial local recurrence-free survival rate at 5 years
in this group was 94.5%. Twenty-five of the 31 local recurrences
that occurred were the first site of relapse.
Eight (32%) of
these were detected at routine clinic appointments, seven (28%)
by routine mammography, and nine (36%) were interim referrals.
Significant risk factors for local recurrence identified were
lymph node status (P = 0.03) and tumour grade (P = 0.04).
One hundred and four patients underwent mastectomy. The actuarial
local recurrence-free survival at 5 years in this group was 85.4%.
Nine of the 13 local recurrences were the first site of relapse.
Six (66.7%) of these were detected at routine appointments.
significant risk factor for local recurrence identified was tumour
grade (P = 0.03).
Overall, 60.1% of metastases presented as interim referrals. Nodal
status, tumour grade and tumour stage were confirmed as significant
risk factors for metastasis (P <= 0.001).
Hazard rate analysis demonstrated a peak incidence of both local
and metastatic recurrences in the second year, diminishing thereafter.
This peak was largely confined to patients with tumours with
poor prognostic features.
We identified only eight patients out of a total of 612 followed
up as outpatients for 5 years who had local recurrences that
were detected at routine appointments and were amenable to salvage
surgery with the prospect of cure.
Therefore it is unlikely that
a reduction in the intensity of outpatient follow-up in the early
years after primary treatment will have a significant impact
on the overall mortality or morbidity of patients with early
Other models of follow-up are discussed, which
could work well provided good communication is maintained amongst
the health care professionals involved.
06/21/2001; Clinical Oncology
Corrine T gives her
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