[Routine check-ups of patients with breast cancer. Significance of the referral pattern for survival after recurrence].

The clinical course of recurrent breast cancer was compared in 117 patients with recurrence diagnosed at routine follow-up visits and 100 patients with recurrence detected in the interval between two scheduled follow-up visits. The interval recurrences were diagnosed after self-appointments (37 cases), after referral by general practitioners (31 cases) or other departments (32 cases). The two groups of patients were comparable with respect to age, menopausal status, initial stage of disease, and the type of adjuvant systemic therapy. The interval group of patients had a longer recurrence-free interval and also more symptoms than the routine group. The anatomical distribution of metastases was comparable in the two groups. The interval group of patients had a shorter survival after recurrence compared to the routine group (median 16 versus 25 months, p = 0.07). The survival from initial diagnosis was comparable in the two groups (48 versus 58 months, p = 0.67). Using multivariate Cox regression analysis, the influence of interval as compared with routine recurrences was evaluated in relationship to other prognostic variables (initial stage, recurrence-free interval, presence of visceral metastases, number of metastatic sites). In this model, the stage of disease, the recurrence-free interval, and presence of visceral metastases were the only significant independent prognostic factors.