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Analysis Of Trends Of Breast Cancer Recurrence Detection
*Trishul Kapoor, Ted James
University of Vermont, College of Medicine, Burlington, VT
OBJECTIVE - To determine how breast cancer recurrences were detected in our sample population of breast cancer survivors. We hypothesize that the majority of breast cancer recurrences are detected by patients.
DESIGN - Retrospective Observational Chart Review.
SETTING - Academic Medical Center, Comprehensive Breast Cancer Center.
PATIENTS - 136/1999 patients were identified with a documented breast cancer recurrence (average age - 56 years) between 2010 and 2015.
INTERVENTION - None
MAIN OUTCOME MEASURES - Categorical: Modality of detection (patient, clinician, scheduled imaging), insurance (Medicare, private), ambulation status (assistance, no assistance), and living situation (isolated, non-isolated). Continuous: age at diagnosis, age at recurrence, and time of recurrence detection.
RESULTS - 106 (78%) of 136 breast cancer recurrences were patient-detected, 16 (12%) were detected by scheduled imaging, and 14 (10%) were clinician-detected. There was a significant difference in time of recurrence detection with respect to mode of detection (P <0.01 patients vs. oncologists & scheduled imaging). Median time to recurrence was 6 years in the patient detection group compared to 3 years each for the clinician and imagining detection groups.
CONCLUSION - The majority of breast cancer recurrences in our patient population are patient-detected, as opposed to routine clinical surveillance exams or scheduled imaging. This finding is unaffected by patient age, insurance, ambulation status, or living situation. There is a significant difference in the modality of breast cancer recurrence detection with respect to time - late recurrences were predominantly patient-detected, whereas early recurrences were detected by clinicians and scheduled imaging studies. This finding supports patient-directed surveillance and provides rationale to limit the duration of clinical follow-up in breast cancer patients.
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