Follow-Up Strategies in the Postirradiated Breast: Techniques Involved in the Detection of Local Recurrences Following Breast Conservation Therapy

Abstract

: Our goal was to delineate parameters involved in the detection of local recurrences of cancer after breast conservation therapy, and to further define standardized follow-up strategies for surveillance of the breast after irradiation. We retrospectively evaluated 152 patients treated with breast conservation therapy who had received a median of 86 months of consecutive clinical and radiographic follow-up at the University of Texas M. D. Anderson Cancer Center from 1978 to 1989. All mammograms were reevaluated by a single radiologist (B. S. J who had no knowledge of the physical or pathologic findings. Local recurrences were found in 13 patients (9%), with a mean time to recurrence of 51 months (median time, 37 months). Age, tumor size, margin status, nuclear grade, estrogen receptor status, nodal status, and the presence of ex-tranodal extension were similar in patients with or without local recurrence. The primary method of detection was physical examination in 10 of the 13 patients (77%); only 3 occult local recurrences were detected by mammography alone. The 13 patients with local recurrences underwent an aver-age number of 14 physical examinations and 5 mammograms in the follow-up period prior to the detection of local recurrence. Our data suggested that, in patients with early stage breast cancer, the incidence of local recurrence after breast conservation therapy is relatively low. Most local recurrences occurred 2 years after breast conservation therapy and were detected by physical examinations. Yearly diagnostic mammograms after breast conservation therapy are sufficient and may complement thorough physical examinations. A new baseline mammogram to evaluate the treated breast at 6 months, after irradiation changes have stabilized, may be useful for future mammogram comparisons.?