[The importance of the follow-up in patients operated on for breast cancer. A retrospective analysis of 2482 cases].

INTRODUCTION: The aim of the follow-up in breast cancer patients is the early detection of recurrences and the diagnosis of second tumours to improve the survival rate and/or the life quality of patients.

MATERIAL AND METHODS: In this study we analyze retrospectively 2482 cases, treated in the period 1964-1988; all patients underwent surgery: mastectomy in 1979 cases and conservative surgery in 503 cases. The follow-up was performed by clinical and radiological (chest X-ray, bone scintigraphic scanning, echotomography of the liver and mammography) examinations every 3-4 months in the first and second year, every 6 months for 5 years and then every year. The duration of the observation time ranges from 42 to 330 months (median 172).

RESULTS: Relapses were detected in 928 cases (37.4%): 289 loco-regional recurrences (11.6%) and 639 distant metastases (25.8%). The 62.1% and the 92.5% of the failures appeared after 3 years and 10 years follow-up respectively. Local recurrences were observed in 14.1% of all relapses after mastectomy and in 9.3% after conservative surgery. 36.3% and 88.1% of the local failures appeared after 2 years and 5 years follow-up respectively. Regional lymph nodal recurrence occurred in 14.2% of all relapses: 1.6% in the axilla, 9.8% in the supraclavicular region, 2.8% in the mediastinal nodes. Distant metastases were observed in 68.9% of all relapses: 31.3% in the bone, 17.6% in the lung and 8.1% in the liver. An increase of the serum markers (CEA, TPA, CA 15-3) appeared 2-10 months before other clinical or radiological signs of disease; CA 15-3 showed the best predictive positive value. Metachronous tumours in the contralateral breast were detected in 103 cases (4.1%), all staged as T1-T2. The modalities of diagnosis of the relapses were studied in 350 patients. In these cases 76% of recurrences were detected by history (62%) and physical examination (14%), 10% by chest X-ray, 12% by bone scan and 2% by liver echotomography. 36% of relapsed patients were asymptomatic and the mean anticipation of diagnosis was 4 months. An increase of survival was observed only in patients with loco-regional recurrences.

CONCLUSIONS: The results obtained in our study and the literature data confirm the importance of long-term follow-up in the breast cancer patients. Clinical examination and mammography represent the most important modalities of diagnosis for the local and distant relapses and the second neoplasms in the contralateral breast.