title: First indicators of relapse in breast cancer: evaluation of the follow-up program at our hospital.
abstract: BACKGROUND
  Guidelines for breast cancer patient follow-up have not been widely adopted in Japan. To assess our intensive follow-up program, we evaluated first relapse and its indicators in patients with breast cancer.
  
  
  METHODS
  Of 964 patients, 126 relapsed and 43 died in the median follow-up term of 45 months. Follow-ups were scheduled every 6-12 months for imaging and tumor marker (TM) evaluation.
  
  
  RESULTS
  Of 126 relapsed patients, 30 (23.8%) had symptoms of relapse. First indicators of relapse in 96 asymptomatic patients were physical examination in 24 patients (19%); imaging, 57 patients (45.3%); and TMs, 15 patients (11.9%). The most sensitive indicators were physical examination for local relapse, ultrasonography for regional lymph nodes, scintigraphy for bone, computed tomography for lung, and TMs for liver metastasis. During intensive follow-up, 43% of relapsed patients were identified by symptoms or physical examination. These patients had poor prognosis compare to patients identified by imaging or TMs in overall survival and post-relapse survival (p = 0.009 and 0.019, respectively). In all 964 patients, the relapse rates for stage I, IIA, IIB, and III tumors were 7.4, 7.9, 19.9, and 43.5%, respectively. The percentage of first relapse detected by imaging or TMs for stage I, IIA, IIB, and III were 4.7, 5.1, 11.8, and 19.8%, respectively. The cost of our follow-up program for 10 years was approximately 290,000 yen per patient.
  
  
  CONCLUSIONS
  A routine intensive follow-up program involving imaging and evaluation of TMs in all patients has low efficacy and high expenditure.
authors.affiliation: Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan. yoshinari@med.osaka-cu.ac.jp
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Katsumi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Izumi
authors.forename: Shiho
authors.initials: S
authors.lastname: Okuma
authors.forename: Makoto
authors.initials: M
authors.lastname: Ichiki
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ikeya
authors.forename: Jyunya
authors.initials: J
authors.lastname: Morimoto
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nishiguchi
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Ikehara
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor