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Ann Surg Oncol. 2016 Oct;23(10):3385-91. doi: 10.1245/s10434-016-5483-x. Epub 2016 Aug 4.

Utility of Clinical Breast Examinations in Detecting Local-Regional Breast Events After Breast-Conservation in Women with a Personal History of High-Risk Breast Cancer.

Author information

1
Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Neuman@surgery.wisc.edu.
2
University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. Neuman@surgery.wisc.edu.
3
Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
4
ACS Clinical Research Program, American College of Surgeons, Chicago, IL, USA.
5
Roswell Park Cancer Institute, Buffalo, NY, USA.
6
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
7
University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
8
Population Health Science, University of Wisconsin, Madison, WI, USA.
9
Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA.
10
Department of Surgery, Wright State University, Dayton, OH, USA.
11
American College of Surgeons Cancer Programs, Chicago, IL, USA.

Abstract

BACKGROUND:

Although breast cancer follow-up guidelines emphasize the importance of clinical examinations, prior studies suggest a small fraction of local-regional events occurring after breast conservation are detected by examination alone. Our objective was to examine how local-regional events are detected in a contemporary, national cohort of high-risk breast cancer survivors.

METHODS:

A stage-stratified sample of stage II/III breast cancer patients diagnosed in 2006-2007 (n = 11,099) were identified from 1217 facilities within the National Cancer Data Base. Additional data on local-regional and distant breast events, method of event detection, imaging received, and mortality were collected. We further limited the cohort to patients with breast conservation (n = 4854). Summary statistics describe local-regional event rates and detection method.

RESULTS:

Local-regional events were detected in 5.5 % (n = 265) of patients. Eighty-three percent were ipsilateral or contralateral in-breast events, and 17 % occurred within ipsilateral lymph nodes. Forty-eight percent of local-regional events were detected on asymptomatic breast imaging, 29 % by patients, and 10 % on clinical examination. Overall, 0.5 % of the 4854 patients had a local-regional event detected on examination. Examinations detected a higher proportion of lymph node events (8/45) compared with in-breast events (18/220). No factors were associated with method of event detection.

DISCUSSION:

Clinical examinations, as an adjunct to screening mammography, have a modest effect on local-regional event detection. This contradicts current belief that examinations are a critical adjunct to mammographic screening. These findings can help to streamline follow-up care, potentially improving follow-up efficiency and quality.

PMID:
27491784
PMCID:
PMC5015646
DOI:
10.1245/s10434-016-5483-x
[Indexed for MEDLINE]
Free PMC Article

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