Follow-up Visits after Breast Cancer: Finding the Optimal Frequency

ABSTRACT

Aim: Numerous international organizations have provided guidelines for clinical follow-up after breast cancer treatment during the first 5 years, ranging from 3 to 6 months with reduced frequency or visits after this. In most guidelines, annual mammography is also recommended. In the face of a global pandemic rise of telemedicine, COVID-19 has forced us to re-examine the efficacy of existing guidelines for in-person follow-up practices. Method(s) Between 2010 to 2020, 3264 patients with early and advanced stage breast cancer treated by breast conserving surgery (BCS) or mastectomy with recorded relapses by December 2021 was analyzed. Mode of detection of the relapse was noted. Result(s) A total of 100 relapses was identified. Twenty-eight of these patients relapsed concurrently with metastatic disease. Locoregional relapse rate in this series was 2.2%. Forty-nine relapses occurred in the ipsilateral breast or chest wall. Fifteen were in the ipsilateral axilla and eight relapses occurred in the both the ipsilateral breast and axilla. Forty-three relapses (43%) were symptomatic, twenty (20%) were detected clinically, thirty (30%) were detected by surveillance mammography, one patient (1%) presented with elevated tumor markers and six (6%) others presented on scheduled CT or PETCT scans. The average time interval between relapse and last mammogram was 16.7 months. Conclusion(s) Routine scheduled in-person assessment still has an important role in the detection of relapses of breast cancer. However, the importance of self-awareness and self-examination should be emphasized and ideally, with a system for early return to the clinic if abnormality is suspected.