'High-intensity post-surgery imaging for breast cancer does not improve survival rates'

High-intensity serial assessment imaging examination after breast cancer surgery has no direct impact on survival rate, according to a new study.

On Tuesday, the Patient-Centered Clinical Research Coordinating Center (PACEN) under the National Evidence-based Healthcare Collaborating Agency (NECA) released the results of a clinical value assessment with the theme of “Optimization of follow-up imaging for remote metastasis detection in breast cancer patients.”

Breast cancer is the most common cancer among women in Korea. Although it is relatively curable compared to other cancers, the risk of recurrence after primary treatment, including surgery, chemotherapy, and radiotherapy, is not low, requiring regular follow-up examinations.

According to international clinical practice guidelines, if there are no metastasis-related symptoms after breast cancer surgery, follow-up imaging tests, such as computed tomography (CT) and bone scans, to check for metastasis are not recommended.

In Korea, however, patients' anxiety about recurrence, short treatment times, and low medical fees have combined to result in frequent screening for practical reasons.

In response to this situation, PACEN and experts in various fields related to breast cancer treatment reviewed the results of the “Optimization of follow-up imaging for remote metastasis detection in breast cancer patients” and presented how to make the most of the study in the medical field.

The study was supported by PACEN, analyzing data from 4,130 patients with invasive breast cancer who underwent mastectomy at 12 university hospitals in Korea from 2010 to 2011.

The results showed that patients who underwent high-intensity follow-up imaging, including CT and bone scans after breast cancer surgery, detected distant metastases faster than those who underwent low-intensity imaging.

However, there was no significant difference in breast cancer-specific survival between the two groups.

It suggests that high-intensity follow-up imaging after breast cancer surgery is beneficial for detecting metastases but is not directly associated with improved survival.

Based on the findings, related experts who participated in the clinical appraisal emphasized that high-intensity surveillance imaging to detect distant metastases early may increase the risk of radiation exposure without a survival benefit and may result in a social and economic burden due to the cost of the test.

Therefore, personalized follow-up based on individual clinical characteristics and symptoms, such as the patient's stage, histologic grade, and hormone receptor type, is needed.

In addition, they suggested that clinical practice should devise a system for establishing testing strategies in consultation with patients and medical staff, develop clinical guidelines for optimal metastasis surveillance tests, and support public clinical research.

“There are about 2 million cancer patients who survive for long after chemotherapy, and they are living with the fear that their cancer will recur at any time, undergoing many follow-up tests,” said Dr. Heo Dae-seog, head of PACEN. “We look forward to expanding public clinical research to other cancers in the future and developing clinical guidelines on how often and what tests cancer survivors should undergo.”