Follow-Up after Treatment of Localized Breast Cancer: Impact of a Planned Screening for the Diagnosis of Relapse in a Cohort of 484 Patients (Pts).
Authors: C. Lévy, D. Allouache, C. Delcambre, O. Switsers, J. Ollivier, K. Gunzer, A. Riviere, P. Berthet, C. Segura, F. Toudic-Emily, C. Blanc-Fournier, T. Delozier
Journal: Cancer Research (2009)

Abstract Background: after a localized breast cancer, none study demonstrates any benefit on survival from extensive follow-up, so international guidelines recommend only annual mammography combined with clinical examination, without any radiological or biological investigation. But nowadays in the era of new drugs (targeted therapies, new cytotoxics) an anticipation of diagnosis of metastatic disease could impact the patient's outcome. However we first need to assess the efficacy of a planned follow-up for the detection of distant recurrences and its potential impact on survival.Method: we conducted a retrospective study in a large cohort of patients (n= 484) included in our center in 4 randomized phase III trials of the breast cancer adjuvant trials program (PACS) of the French cancer centers (FNCLCC). In these trials, a systematic and homogenous follow-up was planned: clinical examination every 6 months combined with an additional radiological (mammogram, chest radiography, liver ultrasonography, bone scan) and biological evaluation, once a year during 5 years. Two adjuvant chemotherapy trials were developed for node-positive pts (PACS 01: 6 FEC 100 (5FU-epirubicine-cyclophosphamide) vs 3 FEC 100 + 3 docetaxel and PACS 04: 6 FEC 100 vs 6 docetaxel-epirubicine +/- trastuzumab for HER2 + pts). For node-negative pts, PACS 05 explored 6 vs 4 FEC100. In PACS 02 (French population of IES trial) hormonal adjuvant therapy was explored, with a comparison of 5 years of Tamoxifen vs a switch of 2-3 years of exemestane after 2-3 years of tamoxifen. Respectively 108 pts were included in PACS 01, 161 in PACS 04, 118 in PACS 05 and 97 in PACS 02.Overall 109 relapses were observed (87 metastasis, 5 local breast recurrence, 7 regional nodal failure, 7 controlateral breast cancers, 3 second malignancies). Fifty-four relapses were diagnosed by the planned follow-up in the absence of clinical symptom and 55 were revealed by clinical symptoms occurring during the interval between two planned investigations. For distant metastasis, 40 were detected by investigations and 47 due to clinical symptoms. For local failure or contro-lateral breast cancer, most relapses were pointed out by annual planned mammography rather than symptomatic disease, respectively 4 and 7. All 3 second malignancies were diagnosed independently of radiographic follow-up.Conclusion: in a homogenous population from adjuvant clinical trials, assigned to a strictly defined extensive follow-up, more than 50% of distant relapses occurred outside this planned program, in favor of a low benefit of extensive follow-up on overall survival for the global population. The final presentation will provide survival data according to the modalities of the recurrences discovery and additional results according to some specific features of primary tumor (node positive/node negative, HER2 positive or triple negative patients) which can eventually impact the benefit of an earlier detection of metastatic disease. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5117.