Most recurrences after breast conservation are detected by regular hospital visits

BMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7071.1548a (Published 14 December 1996) Cite this as: BMJ 1996;313:1548
  1. J M Dixon,
  2. B Norman
  1. Honorary senior lecturer in surgery Edinburgh Breast Unit, Department of Surgery, University of Edinburgh, Royal Infirmary, Edinburgh EH3 9YW
  2. Phase III medical student University of Edinburgh

    EDITOR,—Eva Grunfeld and colleagues state that most recurrences of breast cancer (18 out of 25) were detected by the women themselves between routine visits.1 One must be clear why patients with breast cancer have regular follow up. It is not to detect metastatic disease, as there is clear evidence that early detection and treatment of such disease do not produce benefits.2 The aim is to detect local recurrence so that treatment can be introduced at a stage that optimises the probability of maintaining long term locoregional control.

    We have recently reviewed recurrences occurring in the breast after treatment by wide local excision and radiotherapy. In a series of 55 patients 10 such recurrences were detected by patients themselves, 23 by regular clinical examination in our follow up clinic, and 22 by annual mammography. Recurrences detected by patients were larger than those in the two other groups. Of the 23 detected by regular clinical examination, eight were not visible on mammography. All but one patient with an asymptomatic recurrence were free of metastatic disease and were suitable for a further excision or a mastectomy, compared with six of the 10 with symptoms.

    Our data show that regular clinical follow up does detect local recurrence after breast conservation. After surgery and radiotherapy breasts are difficult to assess, and detecting local recurrences requires specific training. In the Edinburgh Breast Unit trained breast physicians undertake long term follow up of these patients. Each patient is assigned to a specific doctor, and this gets round the biggest complaint of patients attending long term follow up clinics, which is that they see a different doctor each time they visit. It is also a cost effective use of resources, with each doctor seeing 20–24 patients per session.

    As Grunfeld and colleagues point out, their study “provides only limited information about local recurrence.” Our data suggest that, in contrast to metastases, over 80% of recurrences that develop after breast conservation are detected by regular hospital visits. Before regular hospital follow up is abandoned for patients with breast cancer a further study looking specifically at the problem of local recurrence is clearly required.


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