The Added Value of Physical Examination for Breast Cancer Recurrence Detection in Women: A Systematic Review

Abstract

As the number of curatively treated breast cancer patients grows and the burden on healthcare increases, effective use of methods to detect recurrences is becoming more important. This systematic review aims to examine the added value of physical examination (PE) in addition to mammography for breast cancer recurrence detection. PubMed, Web of Science, and Scopus were searched. Observational studies including women with a primary diagnosis of invasive or in situ breast cancer without metastases, which reported method of detection for locoregional recurrences (LRRs), and in which PE was defined as examination by a healthcare provider in an asymptomatic patient were included. Quality was assessed using the ROBINS-1 tool. Nine studies were included with data on 14,406 women, 613 LRRs and 349 secondary primary breast cancers. Of the total LRRs, 46.3% were detected by patients, 23.3% by mammography, and 14.8% by PE. PE detected 11% of the LRRs in patients who had breast conserving surgery and 28% of the LRRs in mastectomy patients. PE detected 7.1% of the contralateral breast cancers and 18.8% of ipsilateral lymph node recurrences, compared to 43.9% and 29.2% by mammography. PE detected a LRR in 0.6% of the patients (91/14,406) and mammography in 1.5% of the patients (143/9614). For detection of breast cancer recurrences, PE is of limited added value alongside mammography and self-detection, although it seems more beneficial for mastectomy patients. Further research is required to determine the effectiveness of the most efficient interval for PE across different patient groups.

Keywords: Contralateral breast cancer; Follow-up; Locoregional recurrence; Mammography; Surveillance.