Surveillance testing in patients with early stage breast cancer: a review

The optimal breast cancer surveillance testing program for early-stage breast cancer patients has not yet been defined. The results of three surveys evaluating patterns of follow-up have indicated that most physicians practice some level of routine surveillance testing (history, physical examination, and yearly mammogram), but there is extreme variation in follow-up practices from physician to physician, especially in the use of blood tests, bone scan, and chest X-ray. The results of numerous retrospective studies and two large randomized prospective studies have indicated that: 1) most recurrences are detected by the history and physical exam; and 2) intensive surveillance testing of asymptomatic patients does not improve overall survival. Several studies on the psychosocial impact of follow-up testing have indicated that: 1) patients desire frequent follow-up visits; 2) patients undervalue the clinical exam and overestimate the value of laboratory and X-ray studies in detecting recurrences.