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 and related to survival. Results: 170 (63%) of the recurrences were detected when they were symptomatic and 100 (37%) when they were not. The groups differed significantly according to the site of recurrence; 45/100 recurrences were local in the asymptomatic group compared with 23/170 (14%) in the symptomatic group. There was no significant difference in disease‐free survival between the two groups. Overall 5‐year survival after primary treatment for all recurrences (locoregional and distant) was significantly better ( p = 0.0003) in the asymptomatic group (62/100) than in the symptomatic group 79/170 (46%). However, when locoregional and distant recurrences were analysed separately no significant differences were found between both groups in overall survival after primary treatment or survival after detection of recurrence. The 5‐year overall survival after primary treatment for distant recurrence was 26/47 (55%) in the asymptomatic group compared with 62/134 (46%) in the symptomatic group ( p = 0.13). For locoregional recurrence these figures were 35/45 (78%) and 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 initially detected during routine follow‐up. Conclusions: We conclude that in the current management of breast cancer the medical impact of follow‐up is low, so follow‐up visits after treatment for breast cancer are hardly warranted. Copyright © 2001 Taylor and Francis Ltd.