University of Oulu

Sylvia Myller, Arja Jukkola, Anniina Jääskeläinen, Nelli Roininen & Peeter Karihtala (2022) How breast cancer recurrences are found – a real-world, prospective cohort study, Acta Oncologica, 61:4, 417-424, DOI: 10.1080/0284186X.2021.2023756

How breast cancer recurrences are found : a real-world, prospective cohort study

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Author: Myller, Sylvia1; Jukkola, Arja2,3; Jääskeläinen, Anniina1;
Organizations: 1Department of Oncology and Radiotherapy, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
2Department of Oncology and Radiotherapy, Tampere University Hospital, Tampere, Finland
3Faculty of Medicine and Health Technology, Tampere Cancer Center, Tampere University, Tampere, Finland
4Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Helsinki, Finland
Format: article
Version: accepted version
Access: open
Persistent link:
Language: English
Published: Informa, 2022


Background: There is very limited data available on how most breast cancer recurrences, either distant metastases or locoregional recurrences (LRR), are actually discovered in routine clinical practice.

Patients and methods: From a prospective cohort of 621 women diagnosed and treated for early invasive breast cancer between 2003 and 2013, we analysed the patients who were later diagnosed with distant metastases (n = 61) and the patients who had locoregional recurrences (LRR; n  = 34). The patients had routine control visits for up to 10 years from initial diagnosis, with annual clinical visits, mammography, blood count, plasma creatinine and liver function tests.

Results: Most distant metastases (n = 38, 62%) were found when a patient contacted health care services because of a symptom; only ten (16%) were detected at pre-planned control visits. The most common first sign or symptom of metastasis was pain (n = 23, 38%). Pain as the first indicator of metastasis indicated a lower survival in metastatic disease (hazard ratio 4.40; 95% confidence interval 1.77–10.94; p = 0.001). How relapse was detected or whether patient was symptomatic did not affect overall survival (OS) of patients with distant metastases. LRRs were mostly found at pre-planned control visits (n = 14, 41%). Abnormalities in routine laboratory tests did not lead to any detection of recurrence.

Discussion: In this prospective, contemporary, real-world study, the vast majority of both distant metastases and LRRs were detected outside the pre-planned control visits. These results highlight the importance of finding ways to lower the threshold for contacting the surveillance unit, rather than frequent routine controls.

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Series: Acta oncologica
ISSN: 0284-186X
ISSN-E: 1651-226X
ISSN-L: 0284-186X
Volume: 61
Issue: 4
Pages: 417 - 424
DOI: 10.1080/0284186x.2021.2023756
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Copyright information: © 2021 Acta Oncologica Foundation. This is an Accepted Manuscript of an article published by Taylor & Francis in Acta Oncologica on 05 Jan 2022, available at: