A study of medical intervention in routine breast cancer follow-up

The incidence and prevalence of breast cancer is increasing, and survival rates continue to climb, placing increasing demands on clinic time. In the modern health service, the value of routine follow-up has been questioned, as there is a very low rate of detection of asymptomatic recurrences in such clinics. The National Institute for Health and Clinical Excellence has recommended potential discharge after the completion of adjuvant treatment. However, there is more to follow-up than the detection of recurrence. This aim of this study was to determine the level and type of intervention occurring within a dedicated hospital breast cancer follow-up clinic, taking into account recent developments in management. We also reviewed the role of community-based breast cancer follow-up as an alternative setting to the hospital.

All patients attending a dedicated breast cancer follow-up clinic within a hospital setting under the care of a single oncologist over a 7 month period were prospectively studied. Information regarding tumour characteristics, in addition to any form of investigation, intervention and trial recruitment, was recorded for 598 patients.

A breast cancer-relevant intervention was carried out in 50% of patients. Forty-seven patients (7.9%) had their breast medication changed, 81 (13.5%) were investigated for suspected recurrence and 44 (7.4%) were enrolled into a clinical trial. Fourteen (2.3%) patients were referred to another specialty; in total, 115 (19.2%) further investigations were carried out related to the disease or treatment.

A significant number of interventions were undertaken from the clinic. A large proportion of these could be co-ordinated from primary care, if adequate guidelines are in place. However, rapid advances in breast cancer management should be considered, and cost-effectiveness needs to be studied before making strong recommendations as to where breast cancer follow-up is best managed.