Follow-up of breast cancer: Time for a new approach?

After treatment for breast cancer women are monitored for recurrent disease by means of routine hospital-based follow-up appointments. The aim of this study is to determine the efficiency of this system, by establishing how r ecurrence presents to our hospital. The study comes at a time of increasing pressure on breast clinics from new patient referrals and the need, since April 1999, to see all cases classified as urgent within two weeks of refer ral. A consecutive series of 643 patients who presented with operable breas t cancer between 1992 and 1998 were reviewed. Details about the 108 patient s who had locoregional or metatstatic relapse were obtained from our breast cancer database and their clinical records. Full data were available on 10 4 patients: 77 (74%) were seen at expedited (interval) appointments and a f urther 18 (17.3%) drew attention to symptoms at a routine visit. Two cases of locoregional recurrence were revealed by surveillance imaging. Unsuspect ed disease, locoregional in all cases, was detected on examination in 7 (6. 7%) patients. The median time to presentation of recurrence was 19 months f or metastatic and 18 months for locoregional disease. Breast cancer recurre nce usually presents to an interval clinic. Most cases that are confirmed f ollowing a routine review are already symptomatic. Long-term routine hospit al follow-up after treatment for breast cancer appears inefficient and unne cessary. Following liaison with local general practitioners we propose to d ischarge patients from routine review after two years. Thereafter they will have scheduled appointments with their GPs with immediate access to specia list review in the breast care unit if required.