The aim of this study was to evaluate the patterns of recurrence and metastatic spread of breast cancers in relation to subtypes and elapsed time since original cancer, to guide follow up imaging.
Between June 2011 and December 2016, all patients with local breast recurrence or distant recurrence after a previous breast cancer had Computed tomography of chest, abdomen and pelvis (CT TAP). All locally advanced primary breast cancers (LABC) also had CT TAP as part of staging investigations. Time to recurrence was stratified in three time frames- ≤ 5 yrs; 6-10 yrs; > 10 yrs. Review of recurrence data, both local and systemic, along with metastasis to organ-specific sites was undertaken.
There were 201 patients with CT TAP in the study group, of which 79 (39.3%) patients had distant metastases. The most significant association was between HER2-positivity and the liver metastases (p = 0.02). Fifty patients (24.7%) had recurrence of cancer. Of these, 24/50 (48%) had local recurrence only, 16 (32%) had distant relapse only and 10/26 (20%) had both local and distant relapse. Time line of recurrence at ≤ 5 yrs; 6-10 yrs; > 10 yrs for local and distant relapse was 13:4:7 and 16:6:4 respectively. 80.4% of local recurrences were symptomatic at the time of presentation.
This study questions the role of routine 'mammogram only' follow in all types of breast cancer. Certain subtypes like HER2/TN could benefit from systemic imaging, along with faster referral after symptoms.