RESULTS OF THE FOLLOW-UP OF OUTPATIENTS W ITH BREAST-CANCER - A PROGRAM OF THE KASSENARZTLICHE-VEREINIGUNG-NORDBADEN AND THE ONCOLOGIC CENTER AT MANNHEIM-UNIVERSITY HOSPITAL

In 1984 a regional program for the follow-up of tumor patients has bee n established in the area of the''Kassenartliche Vereinigung Nordbaden ''. The special feature of this program was the central documentation of all primary and follow-up data. During two years 5411 patients were registered, 2901 with gynecological tumors 64.4 % (N = 1869) of which suffered from breast cancer. 86.4 % of the patients regularly attende d the follow-up. For assessment of a standardized follow-up pattern th e important question has to be answered whether the fixed time interva ls are suited for detection of recurrence and/or metastasis. In the pr esented patients' collective 88.8 % of the recurrence were detected wi thin and only 11.2 % outside the scheduled intervals. It is of conside rable bearing by which diagnostic means the recurrence or metastasis, respectively were detected. In breast cancer patients, detection of re currence was possible in 46.3 % only by intermoderate anamnesis and cl inical examination. Instrumental and laboratory diagnostics were of li mited value only. Detection of metastases occured in 18.1 % by X-ray, in 13 % by scintigraphy, in 9.3 % by sonography and laboratory diagnos tics, in 2 % by computertomography, and also in 2 % by mammography. Th e main areas of recurrence were bone metastases in 30.4 % and local re currence in 24.7 %. 88 % of patients with breast carcinoma received a tumorspecific treatment after diagnosis of recurrence or metastases. 1 3 % of those were treated curatively, 75 % palliatively, and 12 % symp tomatically. The follow-up examination should be continued according t o the given time intervals but should be modified in view of the sympt oms presented. By patients with breast cancer the laboratory diagnosti cs should be limited to the following; alkaline phosphatase, gamma GT, and tumor markers CEA and CA15-3. Ultrasonography of the liver and th e bone scintigraphy should be performed in case of special indications .