„You furrow your brow, doctor. Are you worried about my findings?“ Merits and confusions by a surveillance-schedule for women with operated breast cancer outside a clinical trial

Abstract

Background: Despite recently updated ASCO-Guidelines for breast cancer follow-up a multitude of departments still offer a more or less scheduled surveillance program for patients operated on the disease. Methods: In a retrospective analysis a total amount of 137 female patients with operated invasive (N=118) or non-invasive (N=19) breast cancer is reinvestigated concerning their participation in our surveillance program, especially regarding benefits or disadvantages due to these visits. Selected women were all treated between January 2000 and December 2001 with a Karnofsky-Index of at least 80% and had no previous malignancies. Further excluded from current survey are women with known distant metastasis at the time of the initial surgical procedure. Results: The duration of follow-up was among 5 to 7 years. 103 patients (75.2%) applied the surveillance program in a constant matter. Within these women we had to register 10 local breast cancer relapses, 13 distant metastatic relapses, 1 cholangiocarcinoma and 1 gastric cancer respectively. However another 38 patients (49% off those 77 women who had no relapses or secundary malignancies) were up against an arguable finding followed by additional investigations, fear and in 13 cases (17% of relapse-free individuals) by an invasive procedure (biopsy, reoperation). Conclusions: Scheduled breast-cancer surveillance is a well accepted offer although an appreciable part of patients suffered an anxious period thereby. Since the absence of a proofed benefit regarding pre-clinical detection of breast cancer relapses a surveillance schedule could be adapted to patients individual comfort.