A retrospective study of first indicators of breast cancer recurrence

This study was performed to evaluate the first indicators of breast cancer recurrence in 1,145 patients treated at the University of Texas MD Anderson Cancer Center, between July 1973 and December 1980. Twenty patients were excluded due to incomplete data, resulting in a total number of 1,125 evaluable patients. Data collection included the first metastatic site and its means of detection (symptoms, self-examination, physical examination performed by a physician, and the results of blood and radiological tests). Whether recurrence was found at the scheduled follow-up visits or between the scheduled visits was also analyzed. Symptoms were the primary indicator of relapse for 648 cases (57.6% of the study population). An additional 361 cases (32.1% of the total group) were detected by self-examination or by physician-performed physical examination. Other investigations, e.g. bone scans, liver scans, chest X-rays, and blood tests, revealed recurrent disease in only 116 patients (10. 3% of the population). Among the 1,125 patients, 254 recurrences (22. 6% of the study population) were detected at the scheduled follow-up surveillance and, among these, 64.6% were found by history or physical examination. The distribution of metastatic sites and first indicators of metastases remained constant over time. The scheduled follow-up visits detected a mean of 25.9% of relapses during the first 36 months, while after 36 months only 16.3% of relapses were detected by systematic monitoring. There were no statistically significant differences in disease-free overall survival rates between symptomatic and asymptomatic patients at the time the first recurrence was detected. Moreover, the disease-free and overall survival rates appeared to be the same in symptomatic and asymptomatic patients, whether or not the recurrence was detected by a scheduled follow-up examination. Two conclusions emerged from the present study. Extensive, routine laboratory investigations are not justifiable following curative treatment of primary breast cancer, and it seems reasonable and cost-effective to reduce follow-up surveillance to careful history and physical examination only. The actual method of surveillance does not significantly affect the time interval to metastasis detection and seems inefficient. Clearly, more sensitive methods are needed for earlier detection of recurrent metastatic breast cancer. In addition, early detection of metastases would be even more valuable if more effective treatment modalities of recurrent or metastatic breast cancer were available.