title: Periodic follow-up after breast cancer and the effect on survival.
abstract: OBJECTIVE
  To assess the role of routine follow-up in current management of breast cancer.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Teaching hospital, The Netherlands.
  
  
  METHODS
  270 patients who presented with recurrent breast cancer, 1974-90.
  
  
  METHODS
  Recurrence was coded as asymptomatic or symptomatic and related to survival.
  
  
  RESULTS
  170 (63%) of the recurrences were detected when they were symptomatic and 100 (37%) when they were not. The groups differed significantly according to the site of recurrence; 45/100 recurrences were local in the asymptomatic group compared with 23/170 (14%) in the symptomatic group. There was no significant difference in disease-free survival between the two groups. Overall 5-year survival after primary treatment for all recurrences (locoregional and distant) was significantly better (p=0.0003) in the asymptomatic group (62/100) than in the symptomatic group 79/170 (46%). However, when locoregional and distant recurrences were analysed separately no significant differences were found between both groups in overall survival after primary treatment or survival after detection of recurrence. The 5-year overall survival after primary treatment for distant recurrence was 26/47 (55%) in the asymptomatic group compared with 62/134 (46%) in the symptomatic group (p=0.13). For locoregional recurrence these figures were 35/45 (78%) and 14/23 (61%), respectively (p=0.34). Routine follow-up hardly affected the course of locoregional recurrence. Only five of 75 patients with local recurrence (7%) developed uncontrolled local disease, 2 of whom were initially detected during routine follow-up.
  
  
  CONCLUSIONS
  We conclude that in the current management of breast cancer the medical impact of follow-up is low, so follow-up visits after treatment for breast cancer are hardly warranted.
authors.affiliation: Department of Surgical Oncology, University Hospital St. Radboud, Nijmegen, The Netherlands.
authors.forename: D S
authors.initials: DS
authors.lastname: te Boekhorst
authors.forename: N G
authors.initials: NG
authors.lastname: Peer
authors.forename: R F
authors.initials: RF
authors.lastname: van der Sluis
authors.forename: T
authors.initials: T
authors.lastname: Wobbes
authors.forename: T J
authors.initials: TJ
authors.lastname: Ruers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000378:metabolism; D001943:Breast Neoplasms / Q000401:mortality*; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology; D009569:Nitric Oxide / Q000378:metabolism; D012189:Retrospective Studies; D016019:Survival Analysis; D013629:Tamoxifen / Q000494:pharmacology; D019323:omega-N-Methylarginine / Q000494:pharmacology
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen; D019323:omega-N-Methylarginine; D009569:Nitric Oxide