BALTIMORE--Intensive, laboratory-based follow-up programs for
patients treated for early stage breast cancer do not enhance
survival or reduce morbidity, said John H. Fetting, MD, at a symposium
sponsored by Johns Hopkins Oncology Center, where he is co-director
of the Breast Service.
"There is little information on the cost effectiveness of
these follow-up programs, and what information we have suggests
that screening for metastases is not cost effective," he
Despite the use of physical examinations and laboratory studies,
more than two thirds of breast metastases are discovered by the
patient's own reports of symptoms. "From a public health
perspective, laboratory tests are just not all that valuable as
screening tools," Dr. Fetting commented.
He referred to results from two randomized clinical trials in
Italy comparing intensive use of blood tests, bone scans, mammograms,
chest x-rays, and physical exams with less intensive follow-up
consisting of periodic physical exams and yearly mammograms.
A study from Florence showed a shortening of disease-free survival
in the intensive arm, probably because the cancer was picked up
earlier (although only by a few months). But, Dr. Fetting noted,
the survival rate was the same, suggesting that detecting cancer
early had no benefit, due largely to the "modest" success
of current treatments for metastatic disease.
A second, multicenter study showed no difference between intensive
and min-imalist pathways in time to detection of metastases, survival,
or quality of life.
"As for the value of mammography in detecting cancer in remaining
breast tissue," Dr. Fetting said, "there are no data.
All we can do is make educated guesses." He hypothesized
that, following irradiation, the ability to detect recurrence
in the treated breast is not as good as in the untreated breast.
The value of mammog-raphy screening may also vary according to
the prognosis from the original breast cancer, he said. Its value
would be lower in high-risk patients than in node-negative patients.