title: Risk stratification as a means of reducing the burden of follow-up after completion of initial treatment for breast cancer.
abstract: BACKGROUND
  Little evidence exists regarding the optimum frequency or duration of follow-up for patients with breast cancer. The aim of this study was to assess the effectiveness of a risk-stratified follow-up programme.
  
  
  METHODS
  Patients treated surgically for primary breast cancer from January 2000 to September 2006 were recorded on a BASO database. Follow-up was stratified according to risk of relapse as determined by the Nottingham Prognostic Index (NPI). Patients were assigned to high, moderate or low risk groups. The date of recurrence, time from primary diagnosis and site of relapse were obtained from the database. Review of case notes was used to confirm the method of detection.
  
  
  RESULTS
  1303 women had surgery for primary breast cancer in the study period. Median follow-up was 40 months. Overall survival rate was 96.9% (90.4% high, 97.3% moderate, 99.5% low). Disease free survival was 94.1% (84.1% high, 94.7% moderate, 98.1% low). Seventy-seven recurrences were detected with 39 (51%) in the high risk group, 27 (35%) in the moderate risk group and 11 (14%) in the low risk group. Detection rate at a scheduled appointment was 0.27% overall (low risk 0.14%, moderate risk 0.27%, high risk 0.45%).
  
  
  CONCLUSIONS
  NPI correlates with risk of recurrent disease. Scheduled follow-up yielded few recurrences, suggesting early discharge with open access to clinics could be a safe alternative. This type of follow-up may reduce demand on specialist clinics without significantly affecting patient care or overall survival.
authors.affiliation: Department of General Surgery, Ulster Hospital, Newtownards Road, Dundonald, Co. Down, BT16 1RH, United Kingdom. cathy@doctors.net.uk
authors.forename: C E
authors.initials: CE
authors.lastname: Magee
authors.forename: J A
authors.initials: JA
authors.lastname: Hillan
authors.forename: S A
authors.initials: SA
authors.lastname: Badger
authors.forename: R J
authors.initials: RJ
authors.lastname: Kennedy
authors.forename: S J
authors.initials: SJ
authors.lastname: Kirk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment