S Ciatto1. 1. Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy.
Abstract
BACKGROUND: Early detection of locoregional recurrences of breast cancer is possible with a variety of diagnostic methods. A combination of palpation, sonography and aspiration cytology is probably as accurate and certainly simpler, faster and cheaper compared to other more complicated and costly tests (computerized tomography, magnetic resonance imaging, lymphoscintigraphy). Retrospective studies have estimated that periodic observation may anticipate the detection of local symptomatic recurrences of about 3 months time with respect to their symptomatic onset. After correcting for lead time, this anticipated diagnosis has a moderate to null effect on prognosis (survival from primary treatment) in retrospective studies. According to their natural history, most local recurrences are just a local presentation of diffuse metastatization and, except for a few subgroups (isolated recurrent nodules in the mastectomy scar, isolated axillary nodes), prolonged disease-free survival suggests the absence of associated progressing systemic disease. CONCLUSIONS: Periodic control aimed at the early detection of these local recurrences might be recommended, although the prognostic impact (if any) of such a policy is probably limited, and extremely large controlled studies would be necessary to demonstrate impact at a significant level.
BACKGROUND: Early detection of locoregional recurrences of breast cancer is possible with a variety of diagnostic methods. A combination of palpation, sonography and aspiration cytology is probably as accurate and certainly simpler, faster and cheaper compared to other more complicated and costly tests (computerized tomography, magnetic resonance imaging, lymphoscintigraphy). Retrospective studies have estimated that periodic observation may anticipate the detection of local symptomatic recurrences of about 3 months time with respect to their symptomatic onset. After correcting for lead time, this anticipated diagnosis has a moderate to null effect on prognosis (survival from primary treatment) in retrospective studies. According to their natural history, most local recurrences are just a local presentation of diffuse metastatization and, except for a few subgroups (isolated recurrent nodules in the mastectomy scar, isolated axillary nodes), prolonged disease-free survival suggests the absence of associated progressing systemic disease. CONCLUSIONS: Periodic control aimed at the early detection of these local recurrences might be recommended, although the prognostic impact (if any) of such a policy is probably limited, and extremely large controlled studies would be necessary to demonstrate impact at a significant level.