A Minimalist Policy for Breast Cancer Surveillance

PATIENTS who are diagnosed as having breast cancer are routinely followed up to detect recurrences at an early stage and to institute immediate therapy. There is a belief among patients and physicians that if the recurrence is detected early—when the tumor load is smaller—there is a higher likelihood of disease control, complete remission, or at least extended survival. This approach to the early detection and treatment of metastases has led to routine surveillance of patients. No established guidelines exist for postoperative follow-up of patients with stage I and II breast cancer. Clearly, patients receiving adjuvant therapy require observation during therapy, but the value of follow-up of patients after therapy and of patients who have never received adjuvant therapy has not been established. Most surveillance programs for recurrence of breast cancer include a patient history and physical examination, complete blood cell count, chemistry profile, and tumor marker (either carcinoembryonic antigen or