Survey of the practice of follow-up for the early detection of distant metastases in breast cancer patients in Europe

Data on the current follow-up policy for breast cancer patients were provided by 55 European (EU = 66 348 patients) and 83 Italian (IT = 27 637 patients) centres adhering to two parallel surveys. Chest X-ray (EU = 73%, IT = 78%) and biological markers (EU = 71%, IT = 83%) were more commonly used than bone scintigraphy (EU = 56%, IT = 60%) and liver ultrasonography (EU = 65%, IT 71%). The interval between repeat testing was shorter for biological markers (3–6 months; EU = 64%, IT = 91%) and longer for bone scans (12 months; EU = 77%, IT = 96%), yet about double with respect to currently reported estimates of detection lead time. The use of follow-up testing for asymptomatic metastases was significantly less common in larger centres. Although at least one repeat test was routinely performed in most centres (EU = 87%, IT = 94%), a relevant proportion of centres believed that follow-up has no impact on prognosis (EU = 36%, IT = 53%) or on quality of life (EU = 40%, IT = 43%), and adds no further information to that known of the natural history of the disease (EU = 75%, IT = 65%). This discrepancy suggests that recent controlled studies showing that breast cancer follow-up for early detection of distant metastases is not worthwhile have contributed to a progressive change in our understanding, but a much slower change in follow-up protocols.