Postoperative follow-up of patients with early breast cancer: reappraisal of serum tumor markers.
The purpose of this study was to determine the most appropriate tests and procedures to detect disease progression effectively during the postoperative follow-up of patients with early breast cancer. We reevaluated our current surveillance protocol which involves the intensive follow-up of 643 patients with stage I disease. With the exception of one case of bone metastasis, all cases of recurrence (97%) were suspected from abnormal results detected during surveillance involving physical examination, serial determination of tumor markers, and chest roentgenography. Among 15 patients with asymptomatic distant metastasis, disease recurrence was suspected in 12 (80%) because of increased levels of serum tumor markers. No disease recurrence was detected by routine complete blood counts or automated chemistry studies alone. Our experience indicates that an effective follow-up regimen for patients with early breast cancer may include careful history-taking, physical examination, and the determination of serum tumor markers every 3-6 months for the first 3 years, then less frequently thereafter, and chest roentgenography every 6 months for 5 years, in addition to annual mammography. Serial determination of the tumor markers tumor polypeptide antigen, NCC-ST-439, and either carcinoembryonic antigen or carbohydrate antigen 15-3, seems to be of value for the selection of patients who should undergo radiologic exploration. The health benefits and cost-effectiveness of a follow-up focused on the measurement of serum tumor markers need to be evaluated in large prospective randomized trials.
Anan
Keisei
K
Department of Surgery, Kitakyushu Municipal Medical Center, Japan.
Mitsuyama
Shoshu
S
Tamae
Keiyoshi
K
Suehara
Nobuhiro
N
Nishihara
Kazuyoshi
K
Ogawa
Yoshiaki
Y
Iwashita
Toshimitsu
T
Abe
Yuji
Y
Ihara
Takaaki
T
Nakahara
Shosaku
S
Katsumoto
Fujio
F
Toyoshima
Satoshi
S
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D010808:Physical Examination; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013997:Time Factors
D014408:Biomarkers, Tumor