A retrospective study of first indicators of breast cancer recurrence

This study was performed to evaluate the first indicators of breast cancer recurrence in 1,145 patients treated at the University of Texas MD Anderson Cancer Center, between July 1973 and December 1980. Twenty patients were e xcluded due to incomplete data, resulting in a total number of 1,125 evalua ble patients. Data collection included the first metastatic site and its me ans of detection (symptoms, self-examination, physical examination performe d by a physician, and the results of blood and radiological tests). Whether recurrence was found at the scheduled follow-up visits or between the sche duled visits was also analyzed. Symptoms were the primary indicator of rela pse for 648 cases (57.6% of the study population). An additional 361 cases (32.1% of the total group) were detected by self-examination or by physicia n-performed physical examination. Other investigations, e.g. bone scans, li ver scans, chest X-rays, and blood tests, revealed recurrent disease in onl y 116 patients (10.3% of the population). Among the 1,125 patients, 254 rec urrences (22.6% of the study population) were detected at the scheduled fol low-up surveillance and, among these, 64.6% were found by history or physic al examination. The distribution of metastatic sites and first indicators o f metastases remained constant over time. The scheduled follow-up visits de tected a mean of 25.9% of relapses during the first 36 months, while after 36 months only 16.3% of relapses were detected by systematic monitoring. Th ere were no statistically significant differences in disease-free overall s urvival rates between symptomatic and asymptomatic patients at the time the first recurrence was detected. Moreover, the disease-free and overall surv ival rates appeared to be the same in symptomatic and asymptomatic patients , whether or not the recurrence was detected by a scheduled follow-up exami nation. Two conclusions emerged from the present study. Extensive, routine laboratory investigations are not justifiable following curative treatment of primary breast cancer, and it seems reasonable and cost-effective to red uce follow-up surveillance to careful history and physical examination only . The actual method of surveillance does not significantly affect the time interval to metastasis detection and seems inefficient. Clearly, more sensi tive methods are needed for earlier detection of recurrent metastatic breas t cancer. In addition, early detection of metastases would be even more val uable if more effective treatment modalities of recurrent or metastatic bre ast cancer were available. Copyright (C) 2000 S. Karger AG, Basel.