FOLLOW-UP OF BREAST-CANCER PATIENTS STAGE I-II - A BASE-LINE STRATEGY

In 430 stage I-II breast cancer patients the cost-benefit of investiga tions during follow-up have been studied. Median follow-up time was 8 years and 128 patients had relapsed, 91 with metastatic disease. High costs of routine chest X-ray, limited skeletal X-ray and bone scan exa minations were associated with low incidence of diagnosed relapses not suspected otherwise. In the eight blood analyses examined, increases of more than 10 mm/h in erythrocyte sedimentation rate (ESR), 20 U/l i n gamma-glutamyltransferase (GT) or 60 U/l in alkaline phosphatase (AL P) resulted in a combined sensitivity of 55% and specificity of 91% fo r relapses with distant metastases. Elevation of at least two blood te sts gave a combined sensitivity of 31% and a specificity of 98%. The i mportance of using individual reference values in screening for recurr ences is emphasised. Symptomatic relapse or relapse detected at interv al visits were not independent prognostic factors. The blood tests ALP , ESR and GT were strong predictors of survival measured from relapse which increase their legitimacy in follow-up. A more frequent follow-u p for patients with 4+ involved nodes is proposed: three visits annual ly the first 5 years vs. two visits annually for the others. We conclu de that history, clinical examination, ALP, ESR and GT are sufficient as a baseline screening for relapse in breast cancer patients.