Editorials
1071
EDITORIAL
Why follow up breast cancer patients? Linked Comment: Kontos et al. Int J Clin Pract 2013; 67: 1113–7.
There has been some confusion and controversy regarding the role of clinical follow up in the management of women treated for breast cancer. Millions of women hours have been wasted worldwide in overfilled waiting rooms in the forlorn hope that early diagnosis of ipsilateral recurrence or contralateral new primaries would lead to a survival benefit. What is now recognised is that although mammography has a major role in detection of potentially curable malignancy in the treated and untreated breasts, clinical examination is of very limited value. In this issue, Kontos et al. report an analysis of the annual incidence and method of detection of contralateral disease in women who had either mastectomy or breast conserving surgery (1). They followed a series of 1143 women treated for breast cancer between 1990 and report that the risk of contralateral disease is constant with time, occurring in 0.24% per year. Of those for whom method of relapse detection was known, only 1 (5%) was picked up on clinical examination, 4 (21%) by the patient and 14 (74%) as a result of an abnormal mammogram. This suggests that clinical examination adds little to the benefit of mammography alone. Furthermore, since breast cancer patients have an increased risk of subsequent breast cancer compared with their age-matched neighbours, surveillance in some form has to be a long-term exercise. When Montgomery et al. conducted a systematic review of recurrence detection modalities, they reported a significant change with time (2). Among those studies published before 2000, only 15% of potentially curable relapses were mammographically detected whereas 46% were found as a result of routine clinical examination. For those series published after 2000, of the recurrences, 40% were found by mammography and 15% detected on routine clinical examination. Several studies have indicated the primacy of mammography for posttreatment monitoring. A Dutch study compared outcome for breast cancer patients in Nijmegen where annual mammography was used with that of cases from Eindhoven who had clinical examination without mammography (3). The Nijmegen cases were more likely to have tumours
1071
EDITORIAL
Why follow up breast cancer patients? Linked Comment: Kontos et al. Int J Clin Pract 2013; 67: 1113–7.
There has been some confusion and controversy regarding the role of clinical follow up in the management of women treated for breast cancer. Millions of women hours have been wasted worldwide in overfilled waiting rooms in the forlorn hope that early diagnosis of ipsilateral recurrence or contralateral new primaries would lead to a survival benefit. What is now recognised is that although mammography has a major role in detection of potentially curable malignancy in the treated and untreated breasts, clinical examination is of very limited value. In this issue, Kontos et al. report an analysis of the annual incidence and method of detection of contralateral disease in women who had either mastectomy or breast conserving surgery (1). They followed a series of 1143 women treated for breast cancer between 1990 and report that the risk of contralateral disease is constant with time, occurring in 0.24% per year. Of those for whom method of relapse detection was known, only 1 (5%) was picked up on clinical examination, 4 (21%) by the patient and 14 (74%) as a result of an abnormal mammogram. This suggests that clinical examination adds little to the benefit of mammography alone. Furthermore, since breast cancer patients have an increased risk of subsequent breast cancer compared with their age-matched neighbours, surveillance in some form has to be a long-term exercise. When Montgomery et al. conducted a systematic review of recurrence detection modalities, they reported a significant change with time (2). Among those studies published before 2000, only 15% of potentially curable relapses were mammographically detected whereas 46% were found as a result of routine clinical examination. For those series published after 2000, of the recurrences, 40% were found by mammography and 15% detected on routine clinical examination. Several studies have indicated the primacy of mammography for posttreatment monitoring. A Dutch study compared outcome for breast cancer patients in Nijmegen where annual mammography was used with that of cases from Eindhoven who had clinical examination without mammography (3). The Nijmegen cases were more likely to have tumours
![[Follow-up of 551 patients with node-negative breast cancer].](/assets/img/hold.png)
