Breast Carcinoma Surveillance Counterpoint: Europe

Surveillance for early detection of distant metastases in their asymptomatic phase by various modalities was a routine procedure until the 1990s. Physical examination, chest X-ray and bone scan were performed at varying intervals, possibly combined with liver ultrasonography and serum markers. Uncontrolled studies of the clinical impact of detection of asymptomatic M1 disease, followed by two controlled randomized trials [1, 2], provided convincing evidence that such practices have no significant impact on prognosis, and presently there seems to be general agreement that such regimens have no efficacy. Most European authorities and scientific societies recommend no surveillance for this purpose (Table 55.1). Based on these recommendations and the existing evidence, the common practice of intensive follow-up for the early detection of metastases is disappearing, although slowly [3].