The recent update confirms that a regular physical and yearly mammogram are as effective as more intense methods of examination in detecting recurrent breast cancer.

Rojas MPMP, Telaro E, Moschetti I, Coe L, Fossati R, Liberati A, Rosselli MDT

Published Online:

April 18, 2012

Follow-up examinations are common for women after primary treatment for breast cancer. This is done to detect recurrences at an early stage and begin treatment for any relapses quickly. These tests can include liver scans, tumour markers, chest x-rays and blood and liver function tests. The review of trials found that follow-up programs based on a regular physical exam and yearly mammogram appear to be as effective as the more intensive approaches. This was measured by detection of recurrences of cancers, overall survival and quality of life.

Abstract (click to read)

Background:

Follow-up examinations are commonly performed after primary treatment for women with breast cancer. They are used to detect recurrences at an early (asymptomatic) stage.

Objectives:

To assess the effectiveness of different policies of follow-up for distant metastases on mortality, morbidity and quality of life in women treated for stage I, II or III breast cancer.

Search strategy:

We searched, the Breast Cancer Group's specialized register (May 14, 2004), the Cochrane Controlled Trial Register (Cochrane Library Issue 1, 2004), Medline (January 1966 - May 2004) and EMBASE (1988 - May 2004). References from retrieved articles were also checked.

Selection criteria:

All randomised controlled trials (RCTs) assessing the effectiveness of different policies of follow-up after primary treatment were reviewed for inclusion.

Data collection and analysis:

Two reviewers independently assessed trial quality and eligibility for inclusion in the review. Data were pooled in an individual patient data meta-analysis for the two RCTs testing the effectiveness of different follow-up schemes. Subgroup analyses were conducted by age, tumour size and lymph node status.

Main results:

Four RCTs involving 3055 women with breast cancer (clinical stage I, II or III) were included. Two of these involving 2563 women compared follow-up based on clinical visits and mammography with a more intensive scheme including radiological and laboratory tests. After pooling the data, no significant differences in overall survival (hazard ratio 0.96, 95% confidence interval 0.80 to 1.15) or disease-free survival (hazard ratio 0.84, 95% confidence interval 0.71 to 1.00) emerged. No differences in overall survival and disease-free survival emerged in subgroup analyses according to patient age, tumour size and lymph node status before primary treatment. In 1999, 10-year follow-up data became available for Rosselli Del Turco and no significant differences in overall survival were found.

One RCT (296 women) compared follow-up performed by a hospital-based specialist to follow-up performed by general practitioners. No significant differences in time to detection of recurrence and quality of life emerged. Patient satisfaction was greater among patients treated by general practitioners.
One RCT (196 women) compared regularly scheduled follow-up visits to less frequent visits restricted to the time of mammography. No significant differences emerged in interim use of telephone and frequency of GP's consultations.

Authors' conclusions:

This updated review of RCTs conducted almost 20 years ago suggest that follow-up programs based on regular physical examinations and yearly mammography alone are as effective as more intensive approaches based on regular performance of laboratory and instrumental tests in terms of timeliness of recurrence detection, overall survival and quality of life.

In one RCT, follow-up care performed by trained general practitioners working in an organized practice setting had comparable effectiveness to that delivered by hospital-based specialists in terms of quality of life and time to detection of distant metastases.

This record should be cited as:

Rojas MPMP, Telaro E, Moschetti I, Coe L, Fossati R, Liberati A, Rosselli MDT. Follow-up strategies for women treated for early breast cancer. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001768. DOI: 10.1002/14651858.CD001768.pub2

Assessed as up to date:

May 14, 2004

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Primary Review Group:

Breast Cancer Group

Health topics:

Cancer > Breast > Follow-up

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

The recent update confirms that a regular physical and yearly mammogram are as effective as more intense methods of examination in detecting recurrent breast cancer.

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