The role of chest X-ray in the follow-up of primary breast cancer.

The results of chest X-ray (CXR) survey in the follow-up of 1697 breast cancer patients are reviewed. Intrathoracic metastases (ITM) accounted for 26% of total first recurrences, but the rate dropped to 13% if isolated ITM and to 7% if asymptomatic isolated ITM were considered. Thus the role of CXR survey was limited to the detection of 39 cases of isolated ITM in the asympatomatic phase out of 7100 patients-year for a total number of 11,543 CXR examinations. Moreover, no difference in mean survival was observed if symptomatic and asymptomatic ITM were considered and survival was calculated from the time of first treatment. A small gain of 3 months, not statistically significant, of mean life from metastases diagnosis was recorded for asymptomatic cases, which is probably entirely due to the lead time effect of anticipated diagnosis. CXR survey in breast cancer follow-up may add to the knowledge of the natural history of the disease, but it appears worthless for other purposes. Thus the high costs related to CXR survey may be unacceptable, and a randomized study on the role of CXR is suggested and justified.