Division of Hematology-Oncology, Baystate Medical Center, Springfield, MA.
Division of Hematology-Oncology, Baystate Medical Center, Springfield, MA; University of Massachusetts Medical School-Baystate, Springfield, MA.
Clin Breast Cancer. 2022 Oct;22(7):e818-e824. doi: 10.1016/j.clbc.2022.06.003. Epub 2022 Jun 29.
NCCN and ASCO guidelines recommend breast cancer (BC) follow-up to include clinical breast examination (CBE) every 6 months and annual mammography (AM) for 5 years. Given limited data to support CBE, we evaluated the modes of detection (MOD) of BC-events in a contemporary practice.
We conducted a retrospective review of registry patients with early stage BC (DCIS, Stage I or II) diagnosed between 2010 and 2015 with at least 5 years of follow-up. Second events were defined as malignant (contralateral primary, ipsilateral breast tumor recurrence (IBTR), chest wall recurrence, regional node recurrence or distant relapse) or benign. MOD was categorized as patient complaint, clinical examination or breast imaging.
Sixty-three of 351 BC patients experienced second events. 15 had BC malignant events, including 4 distant disease, 5 contralateral primary, and 3 IBTR. 7/8 of IBTR and contralateral primary BC were AM detected. Patient complaints identified 4/4 distant relapses. Clinical exam identified 2/2 chest wall recurrences in post-mastectomy patients.
Only 2.8% (10/351) of early stage BC patients experienced recurrence during 5 years of follow-up. AM was the predominate MOD of both IBTR and new contralateral primary following breast conserving therapy. Patient complaints prompted evaluation for distant disease. Provider CBE was MOD in only 2/351, 0.6% 95% CI (2.1%-0.1%) of patients as chest wall recurrences postmastectomy. Given modern enhancements to imaging and lower recurrence rates, this data encourages the reassessment of guidelines for every 6-month CBE and provides basis to study telehealth in survivorship care.
NCCN 和 ASCO 指南建议乳腺癌（BC）随访包括每 6 个月进行临床乳房检查（CBE）和每年进行乳房 X 线摄影（AM），持续 5 年。鉴于 CBE 的相关数据有限，我们评估了在当代实践中 BC 事件的检测模式（MOD）。
我们对 2010 年至 2015 年间诊断为早期 BC（DCIS、I 期或 II 期）且至少有 5 年随访期的登记患者进行了回顾性研究。二次事件定义为恶性（对侧原发性、同侧乳房肿瘤复发[IBTR]、胸壁复发、区域淋巴结复发或远处复发）或良性。MOD 分为患者主诉、临床检查或乳房影像学检查。
351 例 BC 患者中有 63 例发生了二次事件。15 例发生了 BC 恶性事件，包括 4 例远处疾病、5 例对侧原发性和 3 例 IBTR。7/8 例 IBTR 和对侧原发性 BC 是通过 AM 检测到的。4/4 例远处复发是通过患者主诉发现的。临床检查在接受乳房切除术的患者中发现了 2/2 例胸壁复发。
只有 2.8%（10/351）的早期 BC 患者在 5 年随访期间发生复发。AM 是保乳治疗后 IBTR 和新对侧原发性的主要 MOD。患者主诉促使对远处疾病进行评估。仅 2/351 例（0.6%；95%CI[2.1%-0.1%]）的患者接受了术后 CBE，CBE 是 MOD。鉴于现代影像学技术的增强和复发率的降低，该数据鼓励重新评估每 6 个月进行 CBE 的指南，并为研究生存者护理中的远程医疗提供依据。
