Follow-up visits after breast cancer: finding the optimal frequency

Abstract

Aim:Numerous international organizations have provided guidelinesfor clinical follow-up after breast cancer treatment during the first5 years, ranging from 3 to 6 months with reduced frequency or visitsafter this. In most guidelines, annual mammography is also recom-mended. In the face of a global pandemic and rise of telemedicine,COVID-19 has forced us to re-examine the efficacy of existing guide-lines for in-person follow-up practices.Methods:Between 2010 to 2020, 3264 patients with early andadvanced stage breast cancer treated by breast conserving surgery(BCS) or mastectomy with recorded relapses by December 2021 wasanalyzed. Mode of detection of the relapse was noted.Results:A total of 100 relapses was identified. Twenty-eight ofthese patients relapsed concurrently with metastatic disease. Locore-gional relapse rate in this series was 2.2%. Forty-nine relapsesoccurred in the ipsilateral breast or chest wall. Fifteen were in the ipsi-lateral axilla and eight relapses occurred in the both the ipsilateralbreast and axilla. Forty-three relapses (43%) were symptomatic,twenty (20%) were detected clinically, thirty (30%) were detected bysurveillance mammography, one patient (1%) presented with elevatedtumor markers and six (6%) others presented on scheduled CT orPETCT scans. The average time interval between relapse and lastmammogram was 16.7 months.Conclusion:Routine scheduled in-person assessment still has animportant role in the detection of relapses of breast cancer. However,the importance of self-awareness and self-examination should beemphasized and ideally, with a system for early return to the clinic ifabnormality is suspected.10EXTRA FREE PAPER