Do regularly scheduled visits result in earlier detection of curable breast cancer recurrences?

Purpose: An important goal of routinely scheduled physical examination in the post-treatment surveillance of patients with early breast cancer (EBC) is to allow for earlier detection of potentially curable recurrences. We present an updated analysis of recurrence detection, and its potential for curative management, at a single-centre survivorship program that follows ASCO recommendations.

Methods: Patients with EBC referred to the Wellness Beyond Cancer Program who had breast cancer recurrence between February 2013 and June 2023 were reviewed. Descriptive analyses were used to present patient and disease characteristics stratified by type of recurrence and mode of cancer detection.

Results: Of 389 first recurrences, 250 were distant (64.3%), 75 local (19.3%), and 64 (16.5%) contralateral new breast primaries. Distant recurrences were primarily detected via patient-reported symptoms (220/250, 88.0%). 42.7% (32/75) of ipsilateral breast recurrences were detected by patients and 53.3% (40/75) by routine imaging. Contralateral breast primaries were primarily detected by routine imaging 71.9% (46/64) and patient-reported symptoms 25.0% (16/64). 2.1% (8/389) recurrences were detected by healthcare providers, 3 were coincidental intraoperative findings and 1.3% (5/389) were detected by healthcare providers at routinely scheduled follow-up visits. Of the 5 recurrences detected at routinely scheduled follow-up visits, only 0.3% (1/389) was potentially curable.

Conclusion: Despite following ASCO guidelines, potentially curable recurrences are rarely detected by healthcare providers at routinely scheduled follow-up appointments. Our data suggests that approximately 87,670 follow-up visits were required for healthcare providers to detect one curable recurrence. Updated evidence-based guidelines are required to optimise the post-treatment surveillance procedures.