Pattern of relapse in low-risk breast cancer patients followed within a community care network

Abstract

International guidelines have set the frame and methods of patients' surveillance after early breast cancer (BC) treatment. Since 1998, delegation of low-risk BC patients follow-up to nonhospital practitioners has been developed within a care network in the Paris region. We used the Gynecomed care network digital database to describe the characteristics of oncological events which occurred in the cohort, and to assess the quality of BC follow-up in relapsing patients. Events were defined as any local, contralateral, or metastatic recurrence, as well as second cancer or death due to any cause. We developed a ranked evaluation method of our surveillance program. Among the 3019 patients followed in the network, 116 (4.3%) patients had 116 events. Median follow-up was 7.1 years (0-51). First events were local-regional relapses, contralateral BCs, metastatic events, second primaries in respectively 52, 26, 14, 24 cases. During the first 5 years, 68.4% of surveillance visits were performed on time, 13.5% were behind schedule and 18.1% were not performed, while 79.1% of mammographies were performed on time, 7.7% behind schedule, and 13.2% were not performed. On schedule examinations allowed diagnosis of 77% of the local-regional, ipsilateral relapses or contralateral BCs, including 38 (69%) discovered by mammographies and 17 (31%) by clinical examination. A nonhospital practitioner care network is able to comply with good surveillance practices and deliver high quality surveillance, in accordance with international guidelines. Delegation of low-risk BC surveillance to nonhospital practitioners is reliable.

LKB1 pro‐oncogenic activity triggers cell survival in circulating tumor cells

“…Despite significant progress toward achieving a high 5year survival rate in the treatment for breast cancer (BC), some patients, nevertheless, relapse and die from incurable metastatic disease (Agopian et al, 2017;Cote et al, 1991;Diel et al, 1996;Jung et al, 2012). Over the last decade, the role of epithelial circulating tumor cells (CTCs) in metastatic induction and their prognostic power has been thoroughly demonstrated (Cristofanilli et al, 2004(Cristofanilli et al, , 2005Hayes et al, 2006;Janni et al, 2016;Rack et al, 2014;Riethdorf et al, 2007;Wallwiener et al, 2013).…”