Rational surveillance programs for early stage breast cancer patients after primary treatment

The majority of women with early stage breast cancers are successfully treated with surgery, radiation therapy and adjuvant systemic therapy. However, 30% of all Stage I and Stage II patients can be expected to experience a relapse. The belief that early detection of recurrences can lead to an increase in survival has been used to justify intensive follow-up regimens following primary treatment of patients with early stage disease. However, the vast majority of data support a program of scheduled surveillance visits and demonstrate that a comprehensive history and physical examination is as efficacious as programs utilizing intensive testing and imaging procedures in the asymptomatic patient. Screening mammography to detect ipsilateral in-breast recurrence or a new primary cancer in the contralateral breast is the only imaging study that is recommended for routine surveillance. Knowledge of the natural history of breast cancer, risk factors for relapse, and the symptoms and physical findings commonly associated with recurrence are central to efficiently and effectively monitoring this cohort of women in clinical practice.