Locoregional relapse after breast cancer: most relapses occur late and are not clinically detected

There remains controversy over follow-up after breast cancer. The National Institute for Clinical Excellence (NICE) in the United Kingdom recommends 2-3 years of follow-up for the detection of locoregional relapse. Guidelines in North America advocate much longer follow up periods. Clinicians in the UK have been reluctant to implement the NICE guidelines. Previous studies report that the rate of relapse peaks in the first 3-5 years before falling off. In this study, a retrospective analysis of rate of relapse and method of detection in 198 patients treated with conservation surgery between 1995 and 2001 has been undertaken. Median follow-up was 5.9 years. Rate of relapse is essentially constant for 10 years, with most relapses occurring after 3 years. The majority of relapse in this cohort is detected by means other than routine clinical examination, with only 16.66% of relapse detected this way. The guidelines for follow-up in the UK need revision. If follow-up is to be provided, this needs to continue for at least 10 years, if not beyond. This study casts doubt on the value of routine clinical examination.