Early Detection of Breast Cancer Recurrences through Periodic follow-up - is it Useless?

Abstract

The authors report on a multicentric consecutive series of 1120 breast cancer first recurrences. Cases detected as subjectively asymptomatic thanks to periodic follow-up examinations are compared to cases detected as symptomatic. The relapse-free interval from primary treatment was shorter for asymptomatic recurrences, confirming that an earlier diagnosis was achieved in these cases. In spite of this diagnostic anticipation, median and actuarial survival from primary treatment did not differ when asymptomatic recurrences were compared to symptomatic recurrences. The study results did not show any prognostic impact of periodic follow-up in breast cancer and urge for prospective controlled studies on this diffuse and expensive practice.

Prolonged survival by 'early' salvage treatment of breast cancer patients: a retrospective 6-year study

“…physical examination, routine laboratory and/or radiological examinations) and have excluded a role for tumour markers (Adair et al, 1974;Bishop et al, 1979;Horton, 1984;Ciatto et al, 1985;Andreoli et al, 1987). Two recent trials (Dixon et al, 1993a and b) have shown a role for tumour markers in guiding therapy and in the monitoring of the response to treatment of metastatic breast cancer patients.…”

“…In patients treated 'early', median survival from salvage treatment and from mastectomy was prolonged when compared with that of patients treated only after metastases were ascertained by radiological means. The prolongation of the former interval might be considered misleading and due to the beginning of salvage treatment 'early' (Horton, 1984;Ciatto et al, 1985;Tomin and Donogan, 1987;Rutgers et al, 1989;Del Turco et al, 1994;Givio, 1994). This is the so-called lead time bias.…”

“…These findings are apparently in contrast with those so far reported in clinical studies with regard to the use of the post-operative follow-up of breast cancer patients. However, in most of these studies, tumour markers were not used at all or were not used with precise criteria to define the 'early' detection of distant metastases (Adair et al, 1974;Bishop et al, 1979;Horton 1984;Ciatto et al, 1985;Andreoli et al, 1987;Tomin and Donogan, 1987;Rutgers et al, 1989;Del Turco et al, 1994;Givio 1994). In our study, the criteria used for interpreting tumour marker levels together with the history and routine laboratory examinations at each follow-up visit kept the number of falsepositive diagnoses of distant metastases to a minimum, simultaneously leading to a great saving in the number of radiological examinations.…”

“…Thus far, the reported studies on the post-operative follow-up of breast cancer patients have not shown any clear benefit; the cost is high and some data suggest that no significant improvement in the survival occurs if relapses are diagnosed by imaging techniques before the appearance of clinical signs (Adair et al, 1974;Bishop et al, 1979;Horton, 1984;Ciatto et al, 1985;Andreoli et al, 1987). As we have previously reported, post-operative monitoring with the CEA-TPA-Cal5-3 association showed 87% sensitivity for the early diagnosis of distant metastases.…”

Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis

“…For two of these six studies, the number of deaths among the patients with recurrences was not available [9,10]. For two studies, no (exact) P-value was available [11,12]. For two studies, the number of deaths among the patients with recurrences was not available, nor the (exact) P-value was available [13,14].…”