Department of Epidemiology, University Medical Center Groningen, University of Groningen, The Netherlands.
Eur J Cancer. 2011 Mar;47(5):676-82. doi: 10.1016/j.ejca.2010.11.006. Epub 2010 Dec 2.
Routine physical examination is recommended in follow up guidelines for women with a history of breast cancer. The objective of this paper is to assess the contribution of routine physical examination in addition to mammography in the early diagnosis of breast cancer recurrences.
The medical follow-up documents of 669 patients were reviewed. 127 contra-lateral breast cancers (CBCs) and 58 loco-regional recurrences (LRRs) in 163 patients were included. The additional contribution of routine physical examination over mammography was evaluated with the proportions of CBCs or LRRs detected by physical examination alone. χ(2) tests were used to compare the difference of contribution of physical examination among subgroups.
Seven (6%) out of 127 CBCs and 13 (22%) out of 58 LRRs were detected by routine physical examination alone. Six LRRs (17%; 6/35) were in patients after breast conserving surgery and seven LRRs (30%; 7/23) in patients after mastectomy. There was a trend that the contribution of physical examination is higher in women under 60 years of age in the detection of CBCs (9%; 5/57) and LRRs (28%, 8/29) than in women over 60 years of age (CBCs:3%; 2/70 and LRRs:17%, 5/29; χ(2)=3.090, P=0.079).
Twenty-two percent of loco regional breast cancer recurrences would have been detected later without physical examination. Routine physical examination may be most valuable for women with a history of breast cancer younger than 60 years at follow-up visit.
在乳腺癌患者的随访指南中推荐常规体格检查。本文的目的是评估常规体格检查除了乳房 X 线摄影术在早期诊断乳腺癌复发中的作用。
回顾了 669 例患者的医学随访文件。纳入了 163 例患者的 127 例对侧乳腺癌（CBC）和 58 例局部区域复发（LRR）。通过单独体格检查发现的 CBC 或 LRR 的比例评估常规体格检查的额外贡献。使用卡方检验比较体格检查在亚组中的贡献差异。
7（6%）例 127 例 CBC 中，13（22%）例 58 例 LRR 中仅通过常规体格检查发现。6 例 LRR（17%；6/35）发生在保乳手术后的患者中，7 例 LRR（30%；7/23）发生在乳房切除术患者中。有一个趋势，在检测 CBC 时，年龄小于 60 岁的女性（9%；5/57）和 LRR（28%，8/29）的体格检查贡献高于年龄大于 60 岁的女性（CBC：3%；2/70 和 LRR：17%，5/29；卡方=3.090，P=0.079）。
22%的局部区域乳腺癌复发如果没有体格检查将被延迟发现。常规体格检查对于随访时年龄小于 60 岁的有乳腺癌病史的女性可能最有价值。
