title: Individual risk profiling for breast cancer recurrence: towards tailored follow-up schemes.
abstract: BACKGROUND
  Breast cancer follow-up is not tailored to the risk of locoregional recurrences (LRRs) in individual patients or as a function of time. The objective of this study was to identify prognostic factors and to estimate individual and time-dependent LRR risk rates.
  
  
  METHODS
  Prognostic factors for LRR were identified by a scoping literature review, expert consultation, and stepwise multivariate regression analysis based on 5 years of data from women diagnosed with breast cancer in the Netherlands in 2005 or 2006 (n=17,762). Inter-patient variability was elucidated by examples of 5-year risk profiles of average-, medium-, and high-risk patients, whereby 6-month interval risks were derived from regression estimates.
  
  
  RESULTS
  Eight prognostic factors were identified: age, tumour size, multifocality, gradation, adjuvant chemo-, adjuvant radiation-, hormonal therapy, and triple-negative receptor status. Risk profiles of the low-, average-, and high-risk example patients showed non-uniform distribution of recurrence risks (2.9, 7.6, and 9.2%, respectively, over a 5-year period).
  
  
  CONCLUSIONS
  Individual risk profiles differ substantially in subgroups of patients defined by prognostic factors for recurrence and over time as defined in 6-month time intervals. To tailor follow-up schedules and to optimise allocation of scarce resources, risk factors, frequency, and duration of follow-up should be taken into account.
authors.affiliation: Department of Health Technology and Service Research, MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, Enschede 7500 AE, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Kraeima
authors.forename: S
authors.initials: S
authors.lastname: Siesling
authors.forename: I M H
authors.initials: IM
authors.lastname: Vliegen
authors.forename: J M
authors.initials: JM
authors.lastname: Klaase
authors.forename: M J
authors.initials: MJ
authors.lastname: IJzerman
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000378:metabolism; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D016017:Odds Ratio; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D047368:Tumor Burden
chemical_list: D015415:Biomarkers