Abstract P5-04-04: Does reducing the frequency of regularly scheduled physical examinations affect recurrence detection in patients with early breast cancer?
Authors: Beltran-Bless Ana-Alicia , Alshamsan Bader I. , Alzahrani Mashari , Hilton John , Baines Kelly-Anne , Samuel Vicky , Pond Gregory R. , Vandermeer Lisa , Clemons Mark , Larocque Gail 
Published: March 2023

Purpose: Follow-up care of patients with early breast cancer (EBC) usually includes routinely scheduled physical examinations. While ASCO guidelines recommend a physical exam every three to six months for the first three years, there is little evidence to support this schedule. Health care systems continue to be challenged to meet the future growth in demand from increasing numbers of diagnosed patients and long-term survivors, scarcity of health care workers, and the need to control health care costs. Despite recognition that new follow-up models are needed, there continues to be no generally accepted well follow-up strategy. We evaluated recurrence detection patterns of patients transferred into a single centre survivorship program that follows ASCO recommendations.

Methods: Consecutive patients with EBC referred to the Wellness Beyond Cancer Program (WBCP) between February 1, 2013, and January 1, 2019, who had breast cancer recurrence, were reviewed. Descriptive analyses were used to present patients and disease characteristics stratified by type of recurrence and mode of cancer detection.

Results: Of 206 recurrences, 135 were distant recurrences (65.5%), 41 were ipsilateral breast recurrences (19.9%), and 30 were contralateral new breast cancers (14.6%). Patient reported symptoms lead to the detection of the majority of distant recurrences (125/135, 92.6%). The most common symptoms of recurrence were bone pain (24.8%), dyspnea/cough (13.1%), abdominal pain (10.7%). Ipsilateral breast recurrences were both quite frequently detected by patients (22/41, 53.7) and by routine mammographic surveillance (17/21, 41.5%). Contralateral breast cancers were primarily detected by imaging 83.3% (25/30). Only 2/206 (1.14%) recurrences/new primaries were detected by a healthcare provider at routinely scheduled follow-up visits. There was a statistical difference in recurrence detection between image detected vs. self-detected in the following factors: grade 3 (26.5% vs 51%, p &lt; 0.007), triple negative breast cancer (3.9% vs. 15.1%, p=0.03), and HER2 disease (18.4% vs. 9.8%, p= 0.04).

Conclusions: Despite regularly scheduled in-person follow-up visits following ASCO guidelines, healthcare providers rarely detect recurrences. Our data suggests that 30,000 – 35, 000 follow-up visits were required for the healthcare providers to detect these 2 recurrences. This leads to further need for proper survivorship programs with patient and provider education, and concentration on targeted surveillance. Provided patients attend regular screening tests, our data points to less frequent in-person follow-up being associated with non-inferior breast cancer-related outcomes. Future prospective studies are required looking at different models of follow-up.

SABCS Abstract Table

Citation Format: Ana-Alicia Beltran-Bless, Bader I. Alshamsan, Mashari Alzahrani, John Hilton, Kelly-Anne Baines, Vicky Samuel, Gregory R. Pond, Lisa Vandermeer, Mark Clemons, Gail Larocque. Does reducing the frequency of regularly scheduled physical examinations affect recurrence detection in patients with early breast cancer? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-04.