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 said.
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.