For people who have had early stage breast cancer and who are at high risk for recurrence/mets, are there still no screening methods for Mets beyond waiting for symptoms to occur?
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- Answered 8 Sep 2019 Conflict of interest declaration: None A 2003 article “Perioperative Screening for Metastatic Disease is not Indicated in Patients with Primary Breast Cancer and no Clinical Signs of Tumor Spread”  reports: “In breast cancer patients without clinical signs of tumor spread perioperative screening for metastases is not warranted because of low frequency of metastases, false positive findings, missing therapeutic consequences and high costs.” A more recent article, from 2015, is “Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”  which reports: “Despite the fact that no randomised data exist to support any particular follow-up sequence or protocol, balancing patient needs and follow-up costs, we recommend regular visits every 3–4 months in the first 2 years, every 6 months from years 3–5 and annually thereafter [V, A]. Every visit should include a thorough history, eliciting of symptoms and a physical examination. Annual ipsilateral (after BCT) and/or a contralateral mammography with ultrasound is recommended [II, A]. An MRI of the breast may be indicated for young patients, especially in cases of dense breast tissue and genetic or familial predispositions. Ultrasound can also be considered in the follow-up of lobular invasive carcinomas [III, B]. In asymptomatic patients, there are no data to indicate that other laboratory or imaging tests (e.g. blood counts, routine chemistry tests, chest X-rays, bone scans, liver ultrasound exams, CT scans, PET/FDG CT or any tumour markers such as CA15–3 or CEA) produce a survival benefit [I, A]. However, routine blood tests are usually indicated to follow-up patients on ET due to the potential side-effects of these drugs, namely in the lipid profile [V, A]. For patients on tamoxifen, an annual gynaecological examination, possibly with a gynaecological ultrasound, by an experienced gynaecologist is recommended [V, B]. Regular bone density evaluation is recommended for patients on AIs [I, A]. Very importantly, most available data for follow-up recommendations come from an era of less sophisticated diagnostic procedures and less efficacious treatment of advanced disease, and new trials are urgently needed to reassess this question. In symptomatic patients or in the case of abnormal findings on examination, appropriate tests should be carried out immediately.” Also published in 2015 was “Metastatic patterns of breast cancer subtypes: What radiologists should know in the era of personalized cancer medicine” . In the discussion they state: “Although current guidelines recommend history, physical, and symptoms as the mainstay in guiding surveillance of the asymptomatic patient, adaptation of imaging may be warranted to stratify follow-up of patients by breast cancer subtype, given the variation in distant metastases and outcomes.” In looking for the answer we came across other papers which we share for interest, even though they don’t directly answer the question: - Bone Imaging in Metastatic Breast Cancer  - Is staging bone scan useful in patients with small invasive breast carcinoma?  - Baseline staging tests after a new diagnosis of breast cancer: further evidence of their limited indications  References 1) https://link.springer.com/article/10.1023/B:BREA.0000003917.05413.ac 2) https://academic.oup.com/annonc/article/26/suppl_5/v8/344805 3) https://www.sciencedirect.com/science/article/abs/pii/S0009926014004097 4) https://imaging.cancer.gov/clinical_trials/docs/MD%20Anderson%20Bone%20Response%20Criteria%202004.pdf 5) https://www.ncbi.nlm.nih.gov/pubmed/19059802 6) https://academic.oup.com/annonc/article/16/2/263/141094