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Top Line: Does surveillance imaging improve survival for patients with locoregionally advanced breast cancer?

The Study: Last week, we learned that an intensive follow up schedule detected more recurrences but didn’t significantly increase survival among women with surgically resected endometrial cancer. This study asked whether asymptomatic detection of recurrent breast cancer leads to better survival outcomes. In contrast to TOTEM, this wasn’t a prospective trial, but it did include a large random sample of >10,000 patients treated for stage II-III breast cancer in 2006-2007 across >1,200 Commission on Cancer (CoC) centers that contribute data to the NCDB. Oncology registrars at each site abstracted clinical records to determine if any imaging that was performed was done for surveillance or for specific signs or symptoms. Among 9560 patients with adequate recurrence information, 1220 developed recurrence (12.8%). The 5-year recurrence rate was 21.9% for TNBC, 13.9% for HER2+, and 10.1% for hormone receptor positive, HER2- breast cancer. Far more recurrences were detected with imaging performed for symptoms (76.7%) than with asymptomatic surveillance imaging (23.3%). Among patients with TNBC and HER2+ breast cancer, the risk of death was significantly lower if their recurrences were detected by asymptomatic surveillance rather than symptomatic imaging. However, there was no reduction in the risk of death among those with hormone receptor positive, HER2- breast cancer.

TBL: Subgroups of patients with high risk breast cancer may benefit from more intensive surveillance imaging rather than symptom-based imaging after primary treatment. | Schumacher, J Natl Cancer Inst 2022


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