Outpatient follow-up after treatment for early breast cancer: Updated results after 5 years

The value of frequent outpatient follow-up in the first few years after pri mary treatment for early breast cancer is a controversial issue. Schedules involving 3-4 monthly visits in the first 2-3 years and B-monthly from year s 3-5 are still commonplace. In this study we audited such a policy from a single cancer centre, identifying a cohort of all 612 patients with early b reast cancer (pT(1-3)pN(0) 1NxM0) referred for adjuvant therapy in 1993. The hospital records were reviewed to ascertain patient and tumour characte ristics, the surgical and adjuvant treatment received, the timing and seque ncing of recurrences and their mode of detection. Five hundred and five patients had breast conservation surgery. The actuari al local recurrence-free survival rate at 5 years in this group was 94.5%. Twenty-five of the 31 local recurrences that occurred were the first site o f relapse. Eight (32%) of these were detected at routine clinic appointment s, seven (28%) by routine mammography, and nine (36%) were interim referral s. Significant risk factors for local recurrence identified were lymph node status (P = 0.03) and tumour grade (P = 0.04). One hundred and four patients underwent mastectomy. The actuarial local rec urrence-free survival at 5 years in this group was 85.4%. Nine of the 13 lo cal recurrences were the first site of relapse. Six (66.7%) of these were d etected at routine appointments. The significant risk factor for local recu rrence identified was tumour grade (P = 0.03). Overall. 60.1% of metastases presented as interim referrals. Nodal status, tumour grade and tumour stage were confirmed as significant risk factors fo r metastasis (P less than or equal to 0.001). Hazard rate analysis demonstrated a peak incidence of both local and metast atic recurrences in the second year, diminishing thereafter. This peak was largely confined to patients with tumours with poor prognostic features. We identified only eight patients out of a total of 612 followed up as outp atients for 5 years who had local recurrences that were detected at routine appointments and were amenable to salvage surgery with the prospect of cur e. Therefore it is unlikely that a reduction in the intensity of outpatient follow-up in the early years after primary treatment will have a significa nt impact on the overall mortality or morbidity of patients with early brea st cancer. Other models of follow-up are discussed, which could work well p rovided good communication is maintained amongst the health care profession als involved.