Affiliations: [a] Mayo Clinic, Department of Surgery, Rochester, MN, USA
| [b]
University of Vermont Medical Center, Department of Surgery, Burlington, VT, USA
| [c]
Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Surgical Oncology, Boston, MA, USA
| [d]
University of Vermont, Department of Mathematics and Statistics, Burlington, VT, USA
Correspondence:
[*]
Corresponding author: Ted A. James, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. Tel.: (617) 667-5509; Fax: (617) 667-9711. E-mail: [email protected]
Abstract: BACKGROUND:After primary surgical resection, breast cancer survivors regularly undergo surveillance using multiple modalities to detect recurrences. OBJECTIVE:The goal of this study was to determine how breast cancer recurrences were detected in our sample population of breast cancer survivors. We hypothesize that the majority of recurrences are patient-detected. METHODS:This was a retrospective observational study evaluating patients with a detected breast cancer recurrence between 2010 and 2015. Patients were analyzed by initial detection modality (patient versus clinician versus imaging). Other variables of interest included insurance status, ambulation capability, living situation, age at diagnosis and recurrence, and time to recurrence. Statistical methods included chi-square tests, log-rank tests, and analysis of variance. RESULTS:115 patients were identified with a recurrence (mean age 61 years). 88 (77%) recurrences were patient-detected, 14 (12%) were detected by imaging, and 13 (11%) were clinician-detected (chi-square goodness of fit test p < 0.001). Median time to recurrence was 4 years in the patient-detection group compared to 3 for the clinician group and 2 for imaging detection (log-rank test p = 0.01). CONCLUSION:While the majority of recurrences were patient-detected, these were detected later and at a more advanced clinical stage. This could represent an opportunity to enhance outcomes by empowering patient detection strategies.
