Poster Presentation Joint 2016 COSA and ANZBCTG Annual Scientific Meeting

The contribution of routine follow-up to the detection of breast cancer recurrence after treatment for early disease. (#296)

Andrew D Redfern 1 , Mihitha Ariyapperuma 2 , Jiuan Ting 3 , Stuart Walter 3 , Hilary Martin 3
  1. University of Western Australia, Applecross, WA, Australia
  2. Medical Oncology, Sr Charles Gairdner Hospital, Perth, Western Australia, Australia
  3. Medical Oncology, Fiona Stanley Hospital, Perth, Western Australia, Australia

Aims:

With increasing incidence and rising survival there is a growing population of breast cancer survivors in Australia. Cancer Australia guidelines recommend a minimum follow-up incorporating seven visits over the first five years, based on level IV evidence, making this a substantial consumer of medical resources. Accepted components include regular histories, examination and annual mammography. We have assessed the value of these individual elements of follow-up through a review of relapse detection mechanisms.

Methods:

We examined the method of detection and mode of recurrence for 241 women (12.5%) relapsing from an initial observed population of 1942 patients with estrogen receptor positive early breast cancer. Data was obtained from a multidisciplinary breast service database with further information accrued from medical records and death certification.

Results:

Relapses included 44 local, 20 regional, 51 contralateral (likely new primary), and 168 distant events. 147 (60%) patients recurred within five years, 75 (31%) between five and 10 years and 21 (9%) after 10 years. Mode of recurrence detection was available on 195 cases and included 21 (11%) detected in routine clinics, 113 (58%) by patient self-detection and early presentation, and 45 (23%) by routine mammography. 64%, 88% and 0% of such cases involved metastatic disease at first relapse. Eight clinic-detected events involved symptom investigation and 13 were locoregional recurrences found on examination, with five of the latter surviving. Initial treatment was endocrine in 55%, chemotherapeutical in 36% and radiotherapeutical in 7%. 2% of patients received best supportive care alone. In seven of the 195 cases relapse detection at an advanced stage potentially limited therapy.

Conclusions:

Overall only one in 10 recurrences were detected by routine follow-up processes, the majority of relapses being diagnosed following self-presentation with symptoms or through mammography. For the purposes of relapse detection, systems of routine mammographic surveillance and patient-driven symptom investigation should take precedence over routine clinic visits.