Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01)

Area of Science:

• Oncology
• Medical Imaging
• Biostatistics

Background:

• Current breast cancer follow-up guidelines recommend imaging for distant metastases only when symptoms are present.
• These guidelines may not reflect recent advancements in imaging technology, systemic therapies, or understanding of breast cancer subtypes.
• The study investigates the impact of how distant recurrence is detected on patient survival.

Purpose of the Study:

• To assess the association between the method of distant breast cancer recurrence detection (asymptomatic imaging vs. symptom-driven) and patient survival.
• To determine if this association varies across different biological subtypes of breast cancer.

Main Methods:

• An observational study analyzed data from 10,076 women diagnosed with stage II-III breast cancer between 2006-2007, followed until 2016.
• Data included mode of recurrence detection (asymptomatic imaging or signs/symptoms), scan details, and patient outcomes.
• Propensity-weighted multivariable Cox proportional hazards models were used to analyze the association between recurrence detection and survival.

Main Results:

• Distant recurrences were detected by asymptomatic imaging in 23.3% of cases and by signs/symptoms in 76.7%.
• Asymptomatic imaging detection was associated with a lower risk of death in triple-negative (HR=0.73) and HER2-positive (HR=0.51) breast cancers.
• No significant association with survival was found for estrogen receptor (ER)- or progesterone receptor (PR)-positive, HER2-negative breast cancers (HR=1.14).

Conclusions:

• Detecting distant recurrence via asymptomatic imaging, compared to symptom detection, is linked to improved survival for triple-negative and HER2-positive breast cancers.
• This association was not observed in ER- or PR-positive, HER2-negative breast cancers.
• A randomized clinical trial is recommended to validate these findings and explore imaging surveillance strategies for specific breast cancer subgroups.