Observational Study

. 2022 Oct 6;114(10):1371-1379.

doi: 10.1093/jnci/djac131.

Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01)

Jessica R Schumacher¹, Heather B Neuman¹, Menggang Yu², David J Vanness³, Yajuan Si⁴, Elizabeth S Burnside⁵, Kathryn J Ruddy⁶, Ann H Partridge^{7

8}, Deborah Schrag^{7

8}, Stephen B Edge⁹, Ying Zhang², Elizabeth A Jacobs¹⁰, Jeffrey Havlena¹, Amanda B Francescatti¹¹, David P Winchester¹¹, Daniel P McKellar^{11

12}, Patricia A Spears¹³, Benjamin D Kozower¹⁴, George J Chang¹⁵, Caprice C Greenberg¹⁶; Alliance ACS-CRP CCDR Breast Cancer Surveillance Working Group

Collaborators, Affiliations

Collaborators

Alliance ACS-CRP CCDR Breast Cancer Surveillance Working Group:
Karla Ballman, Patrick Gavin, Bettye Green, Jane Perlmutter, Elizabeth Berger, Rinaa Punglia, Ronald Chen, Nicole Brys, Taiwo Adesoye

Affiliations

¹ Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI, USA.
² Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
³ Department of Health Policy and Administration, Penn State University, State College, PA, USA.
⁴ Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
⁶ Department of Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, MN, USA.
⁷ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁸ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
¹⁰ Department of Medicine, The University of Texas at Austin, Austin, TX, USA.
¹¹ Commission on Cancer, American College of Surgeons, Chicago, IL, USA.
¹² Department of Surgery, Wright State University, Dayton, OH, USA.
¹³ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁴ Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
¹⁵ Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁶ Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 35913454
PMCID: PMC9552308
DOI: 10.1093/jnci/djac131

Observational Study

Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01)

Jessica R Schumacher et al. J Natl Cancer Inst. 2022.

. 2022 Oct 6;114(10):1371-1379.

doi: 10.1093/jnci/djac131.

Authors

Collaborators

Alliance ACS-CRP CCDR Breast Cancer Surveillance Working Group:
Karla Ballman, Patrick Gavin, Bettye Green, Jane Perlmutter, Elizabeth Berger, Rinaa Punglia, Ronald Chen, Nicole Brys, Taiwo Adesoye

Affiliations

¹ Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI, USA.
² Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.
³ Department of Health Policy and Administration, Penn State University, State College, PA, USA.
⁴ Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
⁶ Department of Oncology, Mayo Clinic Comprehensive Cancer Center, Rochester, MN, USA.
⁷ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁸ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
¹⁰ Department of Medicine, The University of Texas at Austin, Austin, TX, USA.
¹¹ Commission on Cancer, American College of Surgeons, Chicago, IL, USA.
¹² Department of Surgery, Wright State University, Dayton, OH, USA.
¹³ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁴ Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
¹⁵ Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁶ Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

PMID: 35913454
PMCID: PMC9552308
DOI: 10.1093/jnci/djac131

Abstract

Background: Guidelines for follow-up after locoregional breast cancer treatment recommend imaging for distant metastases only in the presence of patient signs and/or symptoms. However, guidelines have not been updated to reflect advances in imaging, systemic therapy, or the understanding of biological subtype. We assessed the association between mode of distant recurrence detection and survival.

Methods: In this observational study, a stage-stratified random sample of women with stage II-III breast cancer in 2006-2007 and followed through 2016 was selected, including up to 10 women from each of 1217 Commission on Cancer facilities (n = 10 076). The explanatory variable was mode of recurrence detection (asymptomatic imaging vs signs and/or symptoms). The outcome was time from initial cancer diagnosis to death. Registrars abstracted scan type, intent (cancer-related vs not, asymptomatic surveillance vs not), and recurrence. Data were merged with each patient's National Cancer Database record.

Results: Surveillance imaging detected 23.3% (284 of 1220) of distant recurrences (76.7%, 936 of 1220 by signs and/or symptoms). Based on propensity-weighted multivariable Cox proportional hazards models, patients with asymptomatic imaging compared with sign and/or symptom detected recurrences had a lower risk of death if estrogen receptor (ER) and progesterone receptor (PR) negative, HER2 negative (triple negative; hazard ratio [HR] = 0.73, 95% confidence interval [CI] = 0.54 to 0.99), or HER2 positive (HR = 0.51, 95% CI = 0.33 to 0.80). No association was observed for ER- or PR-positive, HER2-negative (HR = 1.14, 95% CI = 0.91 to 1.44) cancers.

Conclusions: Recurrence detection by asymptomatic imaging compared with signs and/or symptoms was associated with lower risk of death for triple-negative and HER2-positive, but not ER- or PR-positive, HER2-negative cancers. A randomized trial is warranted to evaluate imaging surveillance for metastases results in these subgroups.

PubMed Disclaimer

Figures

**Figure 1.**
Patient selection consort diagram.

See this image and copyright information in PMC

References

1. American Cancer Society. Breast Cancer Facts & Figures 2017-2018. Atlanta, GA: American Cancer Society; 2017.
1. Khatcheressian JL, Hurley P, Bantug E, et al. ; for the American Society of Clinical Oncology. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961-965. doi: 10.1200/JCO.2012.45.9859. - DOI - PubMed
1. Gradishar WJ, Anderson BO, Balassanian R, et al. Invasive breast cancer version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14(3):324-354. doi: 10.6004/jnccn.2016.0037. - DOI - PubMed
1. GIVIO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. JAMA. 1994;271(20):1587-1592. doi: 10.1001/jama.1994.03510440047031. - DOI - PubMed
1. Grunfeld E, Mant D, Yudkin P, et al. Routine follow up of breast cancer in primary care: randomised trial. BMJ. 1996;313(7058):665-669. doi: 10.1136/bmj.313.7058.665. - DOI - PMC - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01)

Collaborators

Affiliations

Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01)

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous