Materiały źródłowe

• #1 The lingering mysteries of metastatic recurrence in breast cancer | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01161-4

  Metastatic recurrence is a significant problem in patients with breast cancer, the most frequently diagnosed malignancy and the second leading cause of cancer-related death among women worldwide. […] Although the incidence of distant relapse has been shown to be decreasing and survival times for patients with recurrent disease have improved, 20-30% of patients with early breast cancer still die of metastatic disease. […] Protracted intervals between diagnosis and recurrence have been proposed to be the result of tumour dormancy, whereby clinically undetectable minimal residual disease (MRD) can lie asymptomatic for many years to decades. […] Thus, given its systemic nature and inevitable resistance to therapy, metastatic recurrence is largely incurable and remains the foremost concern for cancer patients and their caregivers.

• #2 Stage 4 (IV) Breast Cancer: Survival Rates, Treatment & Prognosis

  https://www.nationalbreastcancer.org/breast-cancer-stage-4/

  Stage 4 breast cancer is advanced breast cancer that has metastasized, or spread, from the original location in the breast to other organs of the body, such as the bones, lungs, liver, or brain. Stage 4 breast cancer is also called metastatic breast cancer or breast cancer recurrence. […] According to the National Cancer Institute, approximately 30% of women initially diagnosed with early-stage breast cancer will ultimately develop Stage 4 (metastatic) breast cancer, often months or years later. […] Although Stage 4 breast cancer is not curable, it is usually treatable. Current advances in research and medical technology mean that more and more women are living longer by managing the disease as a chronic illness with a focus on quality of life as a primary goal. […] Stage 4 breast cancer is the most advanced stage of breast cancer with the lowest survival rate of the breast cancer stages. Survival rates for breast cancer are calculated by the National Cancer Institute (NCI) using a 5-year relative survival rate.

• #3 Breast Cancer Facts & Stats 2024 – Incidence, Age, Survival, & More

  https://www.nationalbreastcancer.org/breast-cancer-facts/

  1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime. […] In 2025, an estimated 316,950 women and 2,800 men will be diagnosed with invasive breast cancer, and an additional 59,080 new cases of non-invasive (in situ) breast cancer will be diagnosed. […] Risk of breast cancer recurrence depends on the type and staging of the initial breast cancer. Typically, the highest risk of recurrence is during the first few years after treatment and decreases over time. […] The 5-year relative survival rate for cancer diagnosed at the localized stage is 99%. […] Breast cancer death rates have slowly decreased since 1989, for an overall decline of 43% through 2020. This is in part due to better screening and early detection efforts, increased awareness, and continually improving treatment options. […] Women who receive regular screenings for breast cancer have a 26% lower breast cancer death rate than women who do not receive screenings.

• #4 New Study Shows a Decline in the Incidence of Recurrent Metastatic Breast Cancer Over Time but no Improvement in Survival – Metastatic Breast Cancer AllianceLink to: MBC Connect Empowers Metastatic Breast Cancer Community with New Mobile App to Leverage P

  https://www.mbcalliance.org/publications/new-study-shows-a-decline-in-the-incidence-of-recurrent-metastatic-breast-cancer-over-time-but-no-improvement-in-survival/

  A retrospective analysis – reported in the journal Breast Cancer Research and Treatment, by Judith Malmgren, PhD, and co-authors – studied 8292 women with stage I-III invasive breast cancer, 964 of whom (11.6%) were later diagnosed with recurrent metastatic breast cancer (rMBC). The authors found a significant decline in rMBC over time, but no increase in survival. Survival after an rMBC diagnosis decreased over time, from 23% in the years between 1990 and 1998, to 21% between 1999 and 2004, and to 13% between 2005 and 2011. […] Findings in the current and previous study show that rMBC patients do worse, both over time and compared to patients with de novo MBC. […] The current study led by Dr. Malmgren builds on the body of research led by the MBC Alliance to answer key questions about the epidemiology of metastatic breast cancer. […] As stated in the new paper, current goals for improving survival of rMBC patients include targeted therapy and better treatments for early-stage triple negative patients, improved screening and awareness, new treatment regimens for rMBC, and universal guideline-compliant care.

• #5 Surveillance After Stage II – III Breast Cancer: Routine Vs. Symptomatic Imaging

  https://www.breastcenter.com/2023/02/08/surveillance-after-stage-ii-iii-breast-cancer-routine-vs-symptomatic-imaging/

  Current guidelines recommend only clinician visits to detect breast cancer recurrence following initial treatment. Imaging is only recommended for those patients demonstrating signs or symptoms of recurrence. […] The cohort consisted of 9560 women with locoregional breast cancer. In the entire cohort, 1220 recurrences were detected. The unadjusted five-year distant recurrence rate was 12.8% (21.9% for patients with triple-negative, 13.9% for HER-2 positive, and 10.1% for ER-positive or PR-positive, HER2 negative cancers.) Recurrences were detected by signs and or symptoms in 76.7% (936 of 1220) and asymptomatic imaging and 23.3% (284 of 1220). […] The researchers noted that this study found no survival advantage with asymptomatic detection of distant recurrence for women with ER-positive or PR-positive, HER2-negative disease. This is significant in that approximately two-thirds of all newly diagnosed breast cancers are this molecular subtype. Consequently, this subtype would likely not benefit from routine imaging on follow-up surveillance. However, it may be that going forward the use of imaging in patients of this molecular subtype with high recurrence scores may be suitable for routine imaging. […] This study however did clearly demonstrate a survival advantage with the use of routine periodic imaging in patients with stage II and III breast cancer that are HER2-positive or triple negative.

• #6

  http://www.bccancer.bc.ca/books/breast/follow-up/detecting-recurrences

  The follow-up of patients who have been treated with curative intent for breast cancer has four main goals: […] All patients who have undergone curative treatment for breast cancer should be seen by a physician every 6 months until 5 years from diagnosis, then annually for a careful history and physical examination including examination of the nodal regions of the head, neck and axilla, breast/chest wall, heart, lung, spine, and abdomen. […] Regular history and physical examination plus annual mammography should aid in early detection of local, regional, or distant metastases. […] Detection of asymptomatic metastases by periodic scheduled investigations has not been shown to increase survival or quality of life. […] Recurrences of triple negative cancer occur most frequently within the first five years following diagnosis and plateau at about 7 years.

• #7

  http://www.bccancer.bc.ca/books/breast/follow-up/detecting-recurrences

  Hormone receptor breast cancers continue to recur over time, out to and beyond ten years. […] A new primary malignancy in the contralateral breast occurs at a rate of approximately 0.5% to 1% per year. […] The average 50 year old woman who has had breast cancer once carries approximately a 10-15% risk of a second contralateral breast cancer (invasive or DCIS) over the next 25 years. […] Women with confirmed BRCA1 and/or 2 mutations should be referred to the high-risk hereditary cancer surveillance program for breast cancer screening with annual MRI followed every six months by mammography. […] Numerous population-based studies report poor long-term compliance with hormone therapy following early breast cancer, even when a patient does not have to pay for the drug. […] Long-term side effects may occur as a result of any part of management of breast cancer. […] Many survivors of breast cancer experience side effects that can significantly affect their quality of life, both in the short and long-term.

• #8 Who’s at Higher Risk for Breast Cancer Recurrence?

  https://www.medscape.com/viewarticle/988719

  When it comes to a woman’s risk for a breast cancer recurrence, hormone status appears to matter. […] New research shows that patients with ER-negative disease have a higher risk of a second breast cancer within a 5-year window post-diagnosis compared with patients with ER-positive disease. […] Breast cancer survivors are at risk for a second breast cancer, making ongoing surveillance essential. […] The researchers found that, at the 5-year mark, the cumulative breast cancer incidence was 7.1% for ER-negative disease and 3.6% for ER-positive disease. At the 10-year mark, the cumulative breast cancer incidence was still higher for women with ER-negative disease 11.8% vs 7.5% among those with ER-positive disease. […] Patients with ER-negative disease also had higher rates of second breast cancers within the first 5 years of follow-ups 16.0 per 1000 person-years vs 7.8 per 1000 person-years for those with ER-positive breast cancer though after 5 years, the rates by ER-status were similar among the two groups (12.1 per 1000 vs 9.3 per 1000 person-years, respectively).

• #9 Breast Cancer Recurrence Risk Persists For More Than 30 Years | BIDMC of Boston

  https://www.bidmc.org/about-bidmc/blogs/living-with-cancer/2022/06/breast-cancer-recurrence-risk-persists-30-years

  Breast cancer recurrence risk persists for more than 30 years. Published in the Journal of the National Cancer Institute, the data comes from a Danish study of more than 20,000 women who were diagnosed with early-stage breast cancer between 1987 and 2004. […] However, between year 10 and year 20, 2,595 women had a breast cancer recurrence. Continuing to follow them, the researchers found that the cumulative incidence of recurrence was 8.5% at 15 years, 12.5% at 20 years, 15.2% at 25 years, and 16.6% at 32 years. […] Women who had primary tumors larger than two centimeters, positive lymph nodes, and ER-positive disease were at higher risk for late recurrence. […] What is clear, though, is that there must be better ways to understand risk and how best to provide surveillance and care for women who need it.

• #10 Factors associated with breast cancer recurrences or mortality and dynamic prediction of death using history of cancer recurrences: the French E3N cohort | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-018-4076-4

  Tumor characteristics are the main prognostic factors for breast cancer outcome. A tumor size larger than 2 cm, axillary nodal involvement, negative estrogen and progesterone receptors, and high grade have been shown to increase the risk of death after breast cancer diagnosis and the risk of locoregional recurrence and metastases. […] Smoking is weakly associated with breast cancer risk but has been associated with a higher risk of death after breast cancer, with a 60% higher risk in current smokers at breast cancer diagnosis and a 50% risk in former smokers of over 35 pack-years. […] The risk of death was strongly dependent on the history of recurrence even after adjusting for the covariates. […] The number of recurrent events greatly affected the risk of death: for the medium risk profile, the probability of death between 5 and 10 years after cancer diagnosis was 6% for no recurrence in the first 5 years after diagnosis, 19% for one recurrence, 36% for two recurrences and 53% for three previous recurrences. […] In conclusion, survival outcomes after a breast cancer are affected by the occurrence of relapses, and the proposed approach (with joint model) is really appropriate to both study their link and to predict the prognosis of patients suffering from a primary breast cancer and with possible relapses.

• #11 Risk for breast cancer recurrence persists past 30 years | MDedge

  https://community.the-hospitalist.org/content/risk-breast-cancer-recurrence-persists-past-30-years

  For the first time, new data show that risk for breast cancer recurrence extends past 30 years. […] Further follow-up showed that 2,595 women had a breast cancer recurrence more than 10 years after their primary diagnosis. […] The cumulative incidence of recurrence was 8.5% at 15 years; 12.5% at 20 years; 15.2% at 25 years, and 16.6% at 32 years. […] Women who had primary tumors larger than 20 mm, lymph node-positive disease, and estrogen receptor-positive tumors were at higher risk for late recurrence. […] Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches, said the investigators, led by Rikke Pedersen, MD, a PhD candidate in epidemiology at Aarhus University Hospital, Denmark. […] Our observed high cumulative incidence of late breast cancer recurrence is a concern given the increasing prevalence of long-term survivors.

• #12 Body Mass Index and Risks of Recurrence and Mortality by Breast Cancer Subtype | Department of Epidemiology

  https://epi.washington.edu/epi_research/body-mass-index-and-risks-of-recurrence-and-mortality-by-breast-cancer-subtype/

  A key modifiable risk factor that may contribute to breast cancer prognosis is body mass index (BMI). […] Among women with TN-tumors, overweight (BMI=25-30kg/m2) women had lower risks of recurrence (HR=0.70, 95%CI=0.52-0.95) and mortality (HR=0.66, 95%CI=0.50-0.88) compared to women with a BMI25kg/m2. […] Women with H2E-tumors who were obese (BMI30kg/m2) had a 2.12-fold (95%CI=1.12-4.04) higher risk of recurrence and 2-fold (95%CI=1.19-3.641) higher risk of mortality than women with BMI25kg/m2. […] Previous studies indicate that obese breast cancer survivors have worse outcomes. However, our results suggest that obesity is associated with increased risks of recurrence and mortality only among younger women with H2E disease.

• #13 Surveillance Monitoring for Breast Cancer Recurrence – Real Pink Podcast

  https://realpink.komen.org/surveillance-monitoring-for-breast-cancer-recurrence/

  The goal of treating early breast cancer is to remove the cancer and keep it from coming back. When breast cancer returns after treatment, this is called a breast cancer recurrence. Most people diagnosed with breast cancer will never have a recurrence. However, everyone who’s had breast cancer is at risk of recurrence, though that risk varies greatly from person to person. Your healthcare provider cannot tell whether or not you might have a recurrence, but they can give you some information about your risk. […] Breast cancer death rates have been steadily decreasing since 1989 where the risk of dying of breast cancer has dropped by 43%, between 1989 and 2020. Although we’ve done significantly better, there’s certainly room to improve. […] In general every 3 to 6 month, is how patients are seen in the clinic. Initially, every 3 and then as time goes by those space out those visits.

• #14 Metastatic Female Breast Cancer Incidence | U.S. Cancer Statistics | CDC

  https://www.cdc.gov/united-states-cancer-statistics/publications/metastatic-breast-cancer.html

  From 2001 to 2021, a total of 4,652,885 new cases of female breast cancer were reported in the United States. Of these, 260,379 (5.6%) were distant stage (metastatic) at diagnosis. The incidence of metastatic female breast cancer increased from 2001 (5.8 per 100,000 females) to 2021 (7.9 per 100,000). […] Distant metastatic breast cancer or cancer that has spread from the breast to distant parts of the body has the lowest cancer survival rate. […] The overall incidence of female breast cancer (at any stage) increased an average of 0.5% per year from 2001 to 2021. Trends for incidence increased the most for cases diagnosed at metastatic stage (1.6%) than at other stages. […] From 2001 to 2021, metastatic female breast cancer incidence was higher among non-Hispanic Black women than among women in all other U.S. racial and ethnic groups.

• #15 Primary Care of Breast Cancer Survivors | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0315/p370.html

  With declining mortality rates, the number of breast cancer survivors is increasing. […] Because of the declining mortality rates, most patients with breast cancer survive and require ongoing surveillance for recurrence and management of sequelae from the disease or its treatment. Primary care physicians are often involved in the care of these patients. […] Guidelines published by the American Cancer Society/American Society of Clinical Oncology emphasize that primary care physicians should ensure that breast cancer survivors follow the recommendations of the oncology team, as well as receive a history and physical examination every three to six months for the first three years after treatment, every six to 12 months for two more years, then annually thereafter. Patients should also be educated about the signs and symptoms of local recurrence.

• #16 Current Approaches and Challenges in Early Detection of Breast Cancer Recurrence

  https://www.jcancer.org/v05p0281.htm

  Current recommendations for breast cancer screening involve radiographic and clinical evaluations. Radiographic studies provide a non-invasive means to detect recurrent or new disease. Mammography is the mainstay of surveillance imaging following curative treatment of breast cancer with 8%-50% of ipsilateral recurrences and 18%-80% of contralateral metachronous cancers detected by mammography alone. […] Identifying the optimal imaging modality for surveillance imaging remains a significant challenge. There are no randomized clinical trials evaluating the effectiveness of breast MRI, ultrasound, or positron-emission computed tomography (PET/CT) in the setting of breast cancer surveillance. […] The overall impact of clinical examinations on survival remains questionable. Although early detection of asymptomatic relapse is known to increase survival, it is uncertain whether clinical examinations contribute to this benefit.

• #17 Primary Care of Breast Cancer Survivors | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0315/p370.html

  Radiologic surveillance should consist of annual mammography of both breasts or the remaining breast. Annual magnetic resonance imaging should be performed only in patients at high risk of recurrence. […] There are no well-established recommendations on screening for cardiotoxicity in breast cancer survivors. However, echocardiography should be considered six to 12 months after breast cancer treatment in asymptomatic patients at high risk of cardiotoxicity. […] The reported occurrences of lymphedema after breast cancer treatment vary widely, depending on the type of treatment received and the criteria used to diagnose lymphedema. […] Guidelines advise primary care physicians to counsel patients about weight management as a strategy to prevent or reduce the risk of lymphedema after breast cancer.

• #18 Examining Breast Cancer Recurrence Detection Methods in a Community Oncology Setting

  https://www.targetedonc.com/view/examining-breast-cancer-recurrence-detection-methods-in-a-community-oncology-setting

  Data from a large study showed that the majority of breast cancer recurrences were self-detected, with only 6.8% found by physician exams, suggesting the need for better screening methods to detect metastatic recurrences earlier. […] Findings showed that there was a high incidence of distant metastatic recurrences. A total of 617 women (13.9%) experienced breast cancer recurrence and in these patients, the median age was 59.2 years and a median body mass index (BMI) of 28.2 kg/m. […] For these recurrences, 69.4% were detected by patient-reported symptoms, 8.1% by routine mammograms, 10.9% by other diagnostic tests, 4.5% incidentally, and 6.8% by routine physician exams. […] The study found that routine survivorship clinical breast exams had a low detection rate for recurrences, with only 6.8% of recurrences being detected this way.

• #19

  https://link.springer.com/article/10.1007/s10549-024-07475-8

  This study corroborates previous research, stating that a majority of all recurrences (71.5%), which includes distant metastasis, and 56.0% of ipsilateral locoregional recurrences are discovered outside of scheduled surveillance. […] Importantly, the probability of detecting a recurrence outside of surveillance was higher among younger patients, patients with lymph node-positive breast cancer, and cases of the HER2-positive breast cancer subtype. […] Most recurrences are detected outside of scheduled surveillance. This study indicates that young age, lymph node-positive breast cancer, and breast cancer of the HER2-positive subtype may call for more intensive surveillance.

• #20 Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01) – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35913454/

  Background: Guidelines for follow-up after locoregional breast cancer treatment recommend imaging for distant metastases only in the presence of patient signs and/or symptoms. However, guidelines have not been updated to reflect advances in imaging, systemic therapy, or the understanding of biological subtype. We assessed the association between mode of distant recurrence detection and survival. […] Results: Surveillance imaging detected 23.3% (284 of 1220) of distant recurrences (76.7%, 936 of 1220 by signs and/or symptoms). Based on propensity-weighted multivariable Cox proportional hazards models, patients with asymptomatic imaging compared with sign and/or symptom detected recurrences had a lower risk of death if estrogen receptor (ER) and progesterone receptor (PR) negative, HER2 negative (triple negative; hazard ratio [HR] = 0.73, 95% confidence interval [CI] = 0.54 to 0.99), or HER2 positive (HR = 0.51, 95% CI = 0.33 to 0.80). No association was observed for ER- or PR-positive, HER2-negative (HR = 1.14, 95% CI = 0.91 to 1.44) cancers.

• #21 :: JBC :: Journal of Breast Cancer

  https://ejbc.kr/DOIx.php?id=10.4048/jbc.2017.20.2.192

  The aim of our study was to investigate the characteristics of primary and recurrent breast cancers and the correlation between cancer subtypes and detection modes. […] Between 2003 and 2013, 147 cases of recurrent breast cancer in 137 women (mean age, 45.3010.78 years) were identified via an annual clinical examination using radiological studies among 6,169 patients with a breast cancer history (mean follow-up period, 13.261.78 years). […] Most recurrent breast cancers showed the same cancer subtype as the primary tumor, and recurrent breast cancer subtypes correlated with the detection modality. Imaging surveillance of survivors of breast cancer might be more beneficial in cases of HR+HER2 type breast cancer or HER2+ type breast cancer than in cases of triple-negative type breast cancer.

• #22 Usefulness of postoperative surveillance MR for women after breast-conservation therapy: Focusing on MR features of early and late recurrent breast cancer | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252476

  To investigate the imaging characteristics of early and late recurrent breast cancer and the detectability of mammography, ultrasonography, and breast magnetic resonance imaging (MRI) in patients who underwent breast-conservation therapy (BCT). […] Total of 1312 women with 2026 surveillance breast MRI after BCT between January 2014 and September 2018 were studied. Early recurrence was defined as newly diagnosed breast cancer and/or axillary metastasis within 12 months of surgery. Late recurrence was defined as recurrence after 12 months of surgery. […] Of the 2026 cases, 103 were confirmed as recurrent breast cancer by biopsy or surgery. Thirty-one cases were early recurrence, and 72 cases were late recurrence. MRI showed significantly higher detectability for recurrent lesions (102 cases, 99%) than mammography (59.4%, p 0.001) or ultrasound (68.9%, p 0.001), or both mammography and ultrasound (81.6%, p 0.001).

• #23 The lingering mysteries of metastatic recurrence in breast cancer | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01161-4

  Despite these guidelines, however, many patients receive high-cost imaging analysis (CT, brain or body MRI, PET and bone scans) and tumour marker blood tests during routine follow-up exams, exposing them to radiation and increasing healthcare costs. […] A major difference between these studies is that modern mammography has been optimised for the sensitive early detection of tumours, whereas the imaging and biomarkers used in the earlier analyses might have been less sensitive. […] The development over the past decade of non-invasive biomarker assays promises to enable the low-cost early detection of cancer. […] Several of these assays have demonstrated success in the early detection of breast cancer recurrence. […] This window of lead time in which ctDNA is detectable in blood, but metastatic recurrence is not yet visible on imaging, provides an exciting opportunity to treat the disease during the dormancy phase.

• #24 CTC Surveillance in Early-Stage Breast Cancer: What’s Next?

  https://www.onclive.com/view/ctc-surveillance-in-earlystage-breast-cancer-whats-next

  CTCs are detectable in approximately 65% or more of patients with metastatic breast cancer (MBC), and a CTC count 5 cells per 7.5 mL of blood in MBC is associated with significantly inferior progression-free survival (PFS) and overall survival (OS), providing evidence for clinical validity. […] CTCs are detectable in about 20% to 25% of patients with localized nonmetastatic breast cancer at the time of diagnosis and also provide independent prognostic information using a lower threshold (1 CTC per 7.5 mL blood) than in MBC (5 CTC per 7.5 mL blood), whether obtained before or after surgery, including after neoadjuvant or adjuvant chemotherapy, providing additional evidence for clinical validity. […] CTCs were detected at 2 years in 18% of 1087 patients with stage II to III breast cancer enrolled in the phase III SUCCESS-A trial, which was one of the trials in which CTC was found to be prognostic at diagnosis.

• #25 Personalized surveillance and aftercare for non-metastasized breast cancer: the NABOR study protocol of a multiple interrupted time series design | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-11504-y

  Because of these reasons and the diversity of patients prognoses, symptoms, needs and preferences, personalization of surveillance and aftercare is recommended. […] However, evidence on the effectiveness of personalisation is lacking, as well as a clear direction on how to personalise follow-up. […] In this study, personalized surveillance is defined as a surveillance trajectory based on individual risk estimations of cancer recurrence and patients preferences, of which a surveillance plan is created in shared decision-making. […] This study investigates the (cost-)effectiveness of a Personalised Surveillance Plan (PSP) and Personalized Aftercare Plan (PAP) on cancer worries and quality of life. […] This study supports the implementation of personalized surveillance and aftercare by developing and updating supporting tools and may provide new insights on the (cost-)effectiveness of personalized follow-up care, based on individual risks and needs.

• #25 Personalized surveillance and aftercare for non-metastasized breast cancer: the NABOR study protocol of a multiple interrupted time series design | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-11504-y

  Follow-up of curatively treated primary breast cancer patients consists of surveillance and aftercare and is currently mostly the same for all patients. A more personalized approach, based on patients individual risk of recurrence and personal needs and preferences, may reduce patient burden and reduce (healthcare) costs. The NABOR study will examine the (cost-)effectiveness of personalized surveillance (PSP) and personalized aftercare plans (PAP) on patient-reported cancer worry, self-rated and overall quality of life and (cost-)effectiveness. […] Each year in the Netherlands, about 15.000 non-metastasized female breast cancer patients start with their follow-up. This growing number of breast cancer survivors increases the demand on follow-up care, which consists of surveillance and aftercare. Surveillance focuses on early detection of locoregional recurrences (LRR) or second primary breast cancers (SPBC) using mammograms and physical examination. Aftercare focuses on prevention, early recognition and treatment of possible (late) physical or psychological effects of breast cancer and its treatment.

• #26 What Is Breast Cancer Surveillance?

  https://www.survivingbreastcancer.org/post/breast-cancer-surveillance-and-recurrence

  Sometimes, despite receiving the best available treatment, a person may experience a recurrence of their breast cancer. This happens because a small number of cancer cells survived the initial treatment and grew into a tumor. […] Breast cancer recurrence is detected through imaging and/or signs and symptoms. During your surveillance period, if you notice changes in your breast tissue, pain, swollen lymph nodes, or other concerning symptoms, contact your care team. […] The SignateraTM Residual Disease Test is a personalized blood test developed by Natera to help people with breast cancer and their doctors watch for recurrence. It works by testing your blood for microscopic pieces of tumor DNA called circulating tumor DNA (ctDNA). […] Signatera™ can provide additional information to inform your surveillance period. Since it works by detecting tiny molecules of your cancer’s DNA, it can help your oncologist determine if traces of cancer are left after treatment or are coming back.

• #27 CTC Surveillance in Early-Stage Breast Cancer: What’s Next?

  https://www.onclive.com/view/ctc-surveillance-in-earlystage-breast-cancer-whats-next

  Evidence-based guidelines recommend surveillance after treatment of localized breast cancer including history, physical examination, and annual mammography. […] Blood-based biomarkers and imaging studies beyond mammography are not recommended in asymptomatic patients, although these recommendations are based on trials performed at a time when diagnostic, imaging, and therapeutic options were limited. […] The availability of more effective therapies for MBC, such as immune checkpoint blockade for triple-negative disease and CDK4/6 inhibitors or novel oral selective estrogen receptor downregulators for HR-positive disease, offers potential for early intervention that could ultimately delay or even prevent metastasis.

• #28

  https://link.springer.com/article/10.1007/s10549-024-07475-8

  The effectiveness of current follow-up guidelines after breast cancer treatment is uncertain. Tailored surveillance based on patient age and tumor characteristics may be more adequate. This study aimed to analyze the frequency of ipsilateral locoregional recurrences (LR) and second primary breast cancers (SP) detected outside of scheduled surveillance and to analyze risk factors associated with these events. […] Most recurrent events were detected outside of scheduled surveillance, particularly for locoregional recurrences. Risk-based surveillance, which takes into account patient and tumor characteristics, might be more suitable for specific patient subsets. […] The overall risk of loco-regional recurrent breast cancer is low (0.30.5% per year after breast conserving therapy), but to detect a recurrence is of great importance to the affected women.

• #29 Personalized surveillance and aftercare for non-metastasized breast cancer: the NABOR study protocol of a multiple interrupted time series design | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-11504-y

  Currently, most Dutch hospitals organize surveillance as one-size fits all, following the national guideline by offering an annual mammogram and physical examination. However, the benefits of these pre-scheduled surveillance visits are limited and may differ by patient. The risk of recurrence is low, depends on patient-, tumor- and treatment-related characteristics and varies over time. For women with a low risk, annual mammograms may be too frequent. […] Intense surveillance has not only limited benefits, but also places a burden on patients and healthcare. For patients, surveillance may provoke distress and cancer worry, which is a very prevalent concern among cancer survivors and can negatively impact quality of life. […] Taken together, current organization of surveillance neglects patients prognoses and preferences, which may cause unnecessary burden and less efficient care.

• #30 Epidemiology, Diagnosis, and Treatment of Breast Cancer Explored at the American Society of Breast Surgeons Meeting – The ASCO Post

  https://ascopost.com/issues/june-15-2012/epidemiology-diagnosis-and-treatment-of-breast-cancer-explored-at-the-american-society-of-breast-surgeons-meeting/

  High-risk breast tumors that respond well to neoadjuvant chemotherapy can be safely treated with lumpectomy, according to University of California, San Francisco, researchers, who determined that tumor biology dictates recurrence in this group, and that local recurrence was low regardless of surgical procedure. […] The I-SPY TRIAL has shown that tumor characteristics such as gene expression, advanced stage, and poor response to neoadjuvant therapy itself were the major predictors of cancer recurrence, and more surgery is not, therefore, necessarily better. […] Tumor size and lymph node status at diagnosis and at the time of surgery were significantly associated with recurrence. Women with poor response to neoadjuvant chemotherapy were also more likely to have recurrent disease. […] Co-investigator Laura Esserman, MD, Co-leader of the Breast Oncology Program at UCSF Helen Diller Family Comprehensive Cancer Center, emphasized that distant metastatic disease, not local recurrence, is the major risk for this patient population.

• #31 Current Approaches and Challenges in Early Detection of Breast Cancer Recurrence

  https://www.jcancer.org/v05p0281.htm

  The current challenge of post-treatment follow up is to best predict which patients are at increased risk of recurrence and then explore the best surveillance strategy in those patients. […] Breast cancer relapses are rarely curable with estimates of only 1-1.5% of women who present each year with recurrent breast cancer having potentially curable disease. However, current data shows a survival benefit from early detection of asymptomatic loco-regional or contra-lateral breast cancer recurrences. […] A multi-disciplinary approach requiring close collaboration between radiologists, medical oncologists, and surgeons is necessary.

• #32 Diagnostic Challenges of Postsurgical Breast Cancer Recurrence

  https://www.asrt.org/promotions/insidejournals/inside-asrt-journals-mammo

  Benefits of MR imaging include the ability to differentiate between benign lesions, such as fat necrosis, skin thickening, seroma, and hematoma, vs malignant lesions presenting in the reconstructed breast. The challenges of detecting and diagnosing postsurgical breast cancer recurrence are met successfully using a variety of imaging tools. […] In these patients, recurrence occurs in the superficial underlying dermal layer of the conserved breast tissue (87.5%) and the deep chest wall (12.5%). The superficial nature of tumors that might arise in the subdermal layer of the breast demonstrates the importance of breast self-examination as recommended by ASCO because early detection is the most important factor in survivability. […] Research shows a variety of methods for clinical follow-up of symptomatic patients depending on provider and institutional protocols. Future studies specifically analyzing whether standardization of protocols in suspected breast cancer recurrence affects survival rates might shed important information on this aspect of clinical care.

• #33 The lingering mysteries of metastatic recurrence in breast cancer | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-01161-4

  In view of advances in imaging and screening technologies, perhaps now is a suitable time to revisit clinical guidelines and determine if new follow-up regimens that use non-invasive biomarker assays, potentially followed by imaging in the case of positive biomarkers, can detect metastatic recurrence early, and whether administering new targeted therapies at these earlier timepoints might improve survival.

• #34 Current Approaches and Challenges in Early Detection of Breast Cancer Recurrence

  https://www.jcancer.org/v05p0281.htm

  Early detection of breast cancer recurrence is a key element of follow-up care and surveillance after completion of primary treatment. The goal is to improve survival by detecting and treating recurrent disease while potentially still curable assuming a more effective salvage surgery and treatment. […] The current rise in breast cancer prevalence intensifies the global need for long-term surveillance programs. This is a consequence of increased diagnosis from breast cancer screening programs and decreased disease-related mortality secondary to improved treatment modalities. […] Studies show detection of asymptomatic breast cancer recurrences by clinical screening carries a more favorable prognosis than patients presenting with symptomatic disease. […] The current standard of care for breast cancer follow-up requires a multi-disciplinary approach from radiologists, surgeons, and primary care physicians.

• #35 Breast Cancer Epidemiology

  https://www.webmd.com/breast-cancer/breast-cancer-epidemiology

  Epidemiology is the study of how often a health condition affects various groups of people and why. Understanding the epidemiology of breast cancer helps scientists and doctors create new and better ways to prevent and treat it. […] Metastatic breast cancer happens when breast cancer cells escape from the breast area and form tumors in other parts of the body. Most often, this happens in the bones, brain, lungs, or liver. About 30% of women who are diagnosed with a less-advanced breast cancer eventually get metastatic breast cancer. […] Early detection and new treatments mean more people survive breast cancer than in the past. The relative survival rate for all breast cancers is more than 90 percent. Relative survival means that people with breast cancer are 90 percent as likely to live for 5 years as people without this cancer.

• #36 What Is Breast Cancer Surveillance?

  https://www.survivingbreastcancer.org/post/breast-cancer-surveillance-and-recurrence

  This period of active surveillance following breast cancer treatment usually lasts about 5 years. However, you can remain in surveillance for the rest of your life as long as you continue to receive cancer monitoring tests. […] Your surveillance plan may include physical exams, mammograms, pelvic exams, bone density tests, and/or other imaging or blood tests. Your oncologist will determine which of these options is best for you, and how often you should receive them. […] Typically, you will have more frequent exams and tests during the first year of your breast cancer surveillance. After that, these appointments become less frequent if you continue to remain free of evidence of cancer. […] During surveillance, you may wonder if your cancer is coming back. About half of breast cancer survivors live with a moderate to severe fear of recurrence.

• #37 Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01) – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35913454/

  Conclusions: Recurrence detection by asymptomatic imaging compared with signs and/or symptoms was associated with lower risk of death for triple-negative and HER2-positive, but not ER- or PR-positive, HER2-negative cancers. A randomized trial is warranted to evaluate imaging surveillance for metastases results in these subgroups.

• #38 Risk for breast cancer recurrence persists past 30 years | MDedge

  https://community.the-hospitalist.org/content/risk-breast-cancer-recurrence-persists-past-30-years

  Among other things, a new model to better select women for prolonged surveillance is needed, they said. […] This study confirms previous investigations, but it is the first to report that breast cancer can recur more than 30 years after diagnosis, note the authors of an accompanying editorial, Serban Negoita, MD, DrPH, and Esmeralda Ramirez-Pea, PhD, MPH, both from the National Cancer Institute. […] The cumulative incidence of late recurrence was also higher in younger patients and those treated with breast-conserving surgery instead of mastectomy, the team reported. […] Adjusted hazard ratios followed the incidence trends, with higher hazards of recurrence for women diagnosed before age 40 as well as those who had breast-conserving surgery, four or more positive lymph nodes, and primary tumors 20 mm or more across.

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