Follow-up for breast cancer: Results of a patients survey

Abstract

568 Background: International guidelines for the surveillance of post-treatment breast cancer patients recommend a clinical follow-up including routine history, physical examination and regularly scheduled mammograms. This often discussed practice has previously been shown not to be inferior when compared to an intensified follow-up in randomized trials performed in the eighties. Patients and Methods: We report the patients’ view on the basis of pooled data of two surveys performed in Germany. The questionnaire was sent out to 2,658 patients with a history of breast cancer. Results: A total of 801 patients (30.1%) answered to the questionnaire. The median age was 57 years (range 23–85 years). More than 80% of the patients were disease-free at the time of the survey. Necessity for surveillance was affirmed by a majority (95.6%), and 40.3% of the patients answered that there was a need for more intensive diagnostic effort with regard to laboratory exams and imaging procedures during follow-up. The main expectation from an intensified follow-up include was the increased feeling of security as expressed by 86.6% of the patients. In contrast to the follow-up guidelines, the present survey indicates that most of the regularly scheduled follow-up visits were expanded using extensive laboratory and imaging procedures (ultrasound 81.9%, CT scan 33.8%). In view of the unsatisfactory evidence on follow-up in breast cancer only 25.7% patients indicated that they would participate in a trial randomising between conventional and more intensive follow-up. Conclusion: The survey indicates that a majority of physicians do not accept the present follow-up guidelines. To some extent this may be explained by the observation that patients and possibly also their doctors trust that intensified follow-up increases diagnostic security. Clearly, a new surveillance study is warranted which investigates the impact of an intensified surveillance on survival based on the greatly improved possibilities of modern diagnostics and treatment. No significant financial relationships to disclose.