DETECTION OF BREAST-CANCER LOCAL RECURRENCES

Background: Early detection of locoregional recurrences of breast canc er is possible with a variety of diagnostic methods. A combination of palpation, sonography and aspiration cytology is probably as accurate and certainly simpler, faster and cheaper compared to other more compl icated and costly tests (computerized tomography, magnetic resonance i maging, lymphoscintigraphy). Retrospective studies have estimated that periodic osservation may anticipate the detection of local symptomati c recurrences of about 3 months time with respect to their symptomatic onset. After correcting for lead time, this anticipated diagnosis has a moderate to null effect on prognosis (survival from primary treatme nt) in retrospective studies. According to their natural history, most local recurrences are just a local presentation of diffuse metastatiz ation and, except for a few subgroups (isolated recurrent nodules in t he mastectomy scar, isolated axillary nodes), prolonged disease-free s urvival suggests the absence of associated progressing systemic diseas e. Conclusions: Periodic control aimed at the early detection of these local recurrences might be recommended, although the prognostic impac t (if any) of such a policy is probably limited, and extremely large c ontrolled studies would be necessary to demonstrate impact at a signif icant level.