title: Methodology to predict a maximum follow-up period for breast cancer patients without significantly reducing the chance of detecting a local recurrence.
abstract: For breast cancer where the prognosis of early stage disease is very good and even when local recurrences do occur they can present several years after treatment, the hospital resources required for annual follow-up examinations of what can be several hundreds of patients are financially significant. If, therefore, there is some method to estimate a maximum length of follow-up Tmax necessary, then cost savings of physicians' time as well as outpatient workload reductions can be achieved. In modern oncology where expenses continue to increase exponentially due to staff salaries and the expense of chemotherapy drugs and of new treatment and imaging technology, the economic situation can no longer be ignored. The methodology of parametric modelling, based on the lognormal distribution is described, showing that useful estimates for Tmax can be made, by making a trade-off between Tmax and the fraction of patients who will experience a delay in detection of their local recurrence. This trade-off depends on the chosen tail of the lognormal. The methodology is described for stage T1 and T2 breast cancer and it is found that Tmax = 4 years which is a significant reduction on the usual maximum of 10 years of follow-up which is employed by many hospitals for breast cancer patients. The methodology is equally applicable for cancers at other sites where the prognosis is good and some local recurrences may not occur until several years post-treatment.
authors.affiliation: Biostatistiques, Institut Curie, 26, rue d'Ulm, 75231 Paris Cedex 05, France. richardfmould@hotmail.com
authors.forename: Richard F
authors.initials: RF
authors.lastname: Mould
authors.forename: Bernard
authors.initials: B
authors.lastname: Asselain
authors.forename: Yann
authors.initials: Y
authors.lastname: De Rycke
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D020000:Decision Support Systems, Clinical; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology*; D010045:Outpatients / Q000706:statistics & numerical data; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors