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The standard follow-up protocol for treated breast cancer patients continues to be the recommended and currently relevant surveillance strategy.

Breast cancer patients who undergo surgery and adjuvant therapy require follow-up to detect recurrent disease or any long-term complications and improve their survival and outcomes. The standard follow-up protocol in these patients is based on studies from the 1990s and 2000s. Studies conducted in the 2000s using intensive surveillance methods reported no comparative improvement in survival. Recent advancements in breast cancer treatment may lead to improved outcomes; hence, there is a need for a re-evaluation of follow-up strategies. A retrospective study published in the Asian Pacific Journal of Cancer Prevention compared outcomes among breast cancer patients followed up with standard vs. intensive surveillance methods.

Patient Characteristics

A total of 412 patients with non-metastatic breast cancer were included in the study. Of these, 213 were allotted to the standard surveillance group and 199 to the alternative follow-up group. The median duration of follow-up was 85 months. There were no significant differences between the groups regarding breast cancer treatment modalities or chemotherapy regimens. Disease recurrence in the standard vs. alternative follow-up groups was 24.9% vs. 18.6%, respectively.

Follow-up Strategies

The standard follow-up group underwent history assessments and physical examinations by a physician every three to four months in the first two years, every six months in the following three years, and annually thereafter, as well as annual breast imaging (i.e., breast ultrasound, mammography, or MRI).
Patients in the alternative follow-up group underwent standard surveillance and annual chest or abdominal imaging or biannual liver function testing.

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Overall and Disease-Free Survival

The median overall survival was not achieved in either group after the median follow-up period, and overall survival was similar in both. Approximately 90% of patients in both groups survived for five years. Disease-free survival, however, was somewhat shorter in the standard surveillance group (p = 0.07). Analysis of the variables revealed that disease-free survival was significantly increased with liver function testing.
Interestingly, the alternative follow-up strategy was correlated with longer disease-free survival in HER-2-positive breast cancer patients.

Treatment and Follow-up of Patients With Recurrent Breast Cancer

Recurrence was treated in all except three patients who did not qualify due to poor performance status. Of these three, two patients who had undergone standard follow-up required additional visits owing to the appearance of new symptoms. However, this phenomenon was not significantly different between the two groups. In the standard surveillance group, the median time between the suspicion of recurrent disease and the commencement of treatment was longer(p = 0.81).

In conclusion, intensive surveillance did not improve overall survival or disease-free survival, and the standard surveillance method remains the recommended standard follow-up strategy in the modern era. Future research is needed to identify potential efficacious diagnostic tools for follow-up in these patients and determine the specific subgroups that will benefit the most from intensive surveillance.

Source

Ithimakin, S., Luengwatthanakit, N., & Wongkraisri, C. (2023). Follow-Up Strategies and Detection of Recurrent Breast Cancer in the Modern Era. Asian Pacific Journal of Cancer Prevention, 24(4), 1359–1366. https://doi.org/10.31557/apjcp.2023.24.4.1359