Mode of Detection of Second Events in Routine Surveillance of Early Stage Breast Cancer Patients |
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| Institution: | 1. Division of Hematology-Oncology, Baystate Medical Center, Springfield, MA;2. University of Massachusetts Medical School-Baystate, Springfield, MA;3. Epidemiology and Biostatics, Baystate Medical Center, Springfield, MA;1. Laboratory of Medical Statistics and Biometry, “Giulio A. Maccacaro,” Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;2. Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy;1. Department of Breast Surgery, Beaumont Hospital, Dublin and Department of Surgery, Royal College of Surgeons, Dublin, Ireland;2. Department of Breast Radiology, Beaumont Hospital, Dublin, Ireland;3. Department of Pathology, Beaumont Hospital, Dublin, Ireland;1. Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, AZ;2. Division of Radiology, Mayo Clinic Arizona, Northwestern Medical Group, Grayslake IL;3. Division of Radiology, Mayo Clinic Arizona, Self Regional Healthcare, Greenwood, SC;4. Division of Health Sciences Research, Mayo Clinic Arizona;1. Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;2. Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People''s Republic of China;3. Department of Chemistry, University of Copenhagen, Copenhagen, Denmark;4. Department of Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany;5. Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;1. Department of Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel;2. Affiliated with the Ben Gurion University Medical School, Beer Sheva, Israel;3. Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel;4. Affiliated with the Hebrew University Medical School, Jerusalem, Israel;5. Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel;6. Department of Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel;7. Department of Radiology, Shamir Medical Center, Be''er Ya''akov, Israel;8. Affiliated with the Sackler School of Medicine, Tel Aviv University;9. Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel |
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| Abstract: | IntroductionNCCN and ASCO guidelines recommend breast cancer (BC) follow-up to include clinical breast examination (CBE) every 6 months and annual mammography (AM) for 5 years. Given limited data to support CBE, we evaluated the modes of detection (MOD) of BC-events in a contemporary practice.MethodsWe conducted a retrospective review of registry patients with early stage BC (DCIS, Stage I or II) diagnosed between 2010 and 2015 with at least 5 years of follow-up. Second events were defined as malignant (contralateral primary, ipsilateral breast tumor recurrence (IBTR), chest wall recurrence, regional node recurrence or distant relapse) or benign. MOD was categorized as patient complaint, clinical examination or breast imaging.ResultsSixty-three of 351 BC patients experienced second events. 15 had BC malignant events, including 4 distant disease, 5 contralateral primary, and 3 IBTR. 7/8 of IBTR and contralateral primary BC were AM detected. Patient complaints identified 4/4 distant relapses. Clinical exam identified 2/2 chest wall recurrences in post-mastectomy patients.ConclusionsOnly 2.8% (10/351) of early stage BC patients experienced recurrence during 5 years of follow-up. AM was the predominate MOD of both IBTR and new contralateral primary following breast conserving therapy. Patient complaints prompted evaluation for distant disease. Provider CBE was MOD in only 2/351, 0.6% 95% CI (2.1%-0.1%) of patients as chest wall recurrences postmastectomy. Given modern enhancements to imaging and lower recurrence rates, this data encourages the reassessment of guidelines for every 6-month CBE and provides basis to study telehealth in survivorship care. |
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