Patterns in detection of recurrence among patients treated for breast cancer.

Abstract

e14020 Background: Follow-up programs for breast cancer should according to ASCO and ESMO consist of regular visits including anamnestic screening for symptoms of recurrence and physical examination for ten years in addition to regular mammography. Recently, the Danish guideline for follow-up after early breast cancer was revised. Today most patients are offered open access to an outpatient clinic, but no scheduled visits following the first year after surgery. This strategy has been studied in regards to psychological and health related quality of life outcomes, but not in regards to detection of recurrence and survival. The aim of this study was to quantify the recurrences detected at scheduled outpatient visits in Denmark before the implementation of revised follow-up guidelines. Furthermore, we aimed to assess whether the duration of symptoms prior to recurrence detection differed depending on type of visit when recurrence was detected. Methods: We conducted a cross-sectional study among 310 patients with recurrent breast cancer. Through medical records, we retrieved information on type of visit when recurrence was detected, localization of recurrence, symptoms reported, and duration of symptoms. Tumor characteristics were obtained from the Danish Breast Cancer Group database. Results: Among the 310 breast cancer recurrences, more than half were distant (59%), 26% were loco-regional, and 15% loco-regional and distant. Among the 199 patients still in outpatient follow-up at time of recurrence, recurrence was detected at a scheduled outpatient visit (21%), at a patient-requested extra outpatient visit (15%), by the general practitioner or other specialist (47%), or on a scheduled mammography (11%). Among patients with recurrence detected at a scheduled outpatient visit, the majority (88%) reported symptoms related to the recurrence. Patients who waited for the scheduled outpatient visit despite symptoms had a markedly longer duration of symptoms (median 21 weeks) prior to detection of recurrence than patients who requested an extra visit (median 8 weeks). Conclusions: One-fifth of recurrences among patients attending outpatient follow-up were detected at scheduled outpatient visits. The majority was symptomatic, but the patients had not altered their scheduled appointment. Whether recurrences like these will be detected in follow-up without scheduled visits is unknown. Some recurrences may be detected earlier, if patients can be educated to react on relevant symptoms, but some recurrences may be detected with further delay. Thus, more research in this area is needed.