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- Title
Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01).
- Authors
Schumacher, Jessica R; Neuman, Heather B; Yu, Menggang; Vanness, David J; Si, Yajuan; Burnside, Elizabeth S; Ruddy, Kathryn J; Partridge, Ann H; Schrag, Deborah; Edge, Stephen B; Zhang, Ying; Jacobs, Elizabeth A; Havlena, Jeffrey; Francescatti, Amanda B; Winchester, David P; McKellar, Daniel P; Spears, Patricia A; Kozower, Benjamin D; Chang, George J; Greenberg, Caprice C
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
PROTEINS; CELL receptors; RESEARCH funding; BREAST tumors; PROPORTIONAL hazards models
- Publication
JNCI: Journal of the National Cancer Institute, 2022, Vol 114, Issue 10, p1371
- ISSN
0027-8874
- Publication type
journal article
- DOI
10.1093/jnci/djac131