Periodic follow-up after breast cancer and the effect on survival

Objective: To assess the role of routine follow-up in current management of breast cancer. Design: Retrospective review. Setting: Teaching hospital, The Netherlands. Subjects: 270 patients who presented with recurrent breast cancer, 1974-90. Main outcome measure: Recurrence was coded as asymptomatic or symptomatic a nd related to survival. Results: 170 (63%) of the recurrences were detected when they were symptoma tic and 100 (37%) when they were not. The groups differed significantly acc ording to the site of recurrence; 45/100 recurrences were local in the asym ptomatic group compared with 23/170 (14%) in the symptomatic group. There w as no significant difference in disease-free survival between the two group s. Overall 5-year survival after primary treatment for all recurrences (loc oregional and distant) was significantly better (p=0.0003) in the asymptoma tic group (62/100) than in the symptomatic group 79/170 (46%). However, whe n locoregional and distant recurrences were analysed separately no signific ant differences were round between both groups in overall survival after pr imary treatment or survival after detection of recurrence. The 5-year overa ll survival after primary treatment for distant recurrence was 26/47 (55%) in the asymptomatic group compared with 62/134 (46%) in the symptomatic gro up (p = 0.13). For locoregional recurrence these figures were 35/45 (78%) a nd 14/23 (61 %), respectively (p = 0.34). Routine follow-up hardly affected the course of locoregional recurrence. Only five of 75 patients with local recurrence (7%) developed uncontrolled local disease, 2 of whom were initi ally detected during routine follow-up. Conclusions: We conclude that in the current management of breast cancer th e medical impact of follow-up is low, so followup visits after treatment fo r breast cancer are hardly warranted.