A suitable case for reappraisal

As the morning progresses the hospital waiting area fills up with anxious, mostly grey haired women. They have been treated for breast cancer in the past and are attending for “routine” follow up. For those who are apparently free of disease, what is the purpose of follow up, how often should it be done, and by whom, and what investigations, if any, should be performed routinely?

A recent consensus statement focuses on these issues1 and is particularly valuable in highlighting interventions of no value and areas of continued uncertainty. The main purpose of follow up is summarised as “the earliest possible diagnosis of a relapse with a view to applying a curative second line treatment.” How often do we achieve this?

Distant metastatic disease is currently incurable, so its detection is not part of the main purpose of follow up. In any case, routine follow up is a poor way of detecting distant metastatic relapse: three quarters of cases will present between scheduled visits.2 Two recent randomised …