Individual risk profiling for breast cancer recurrence: towards tailored follow-up schemes

Background: Breast cancer follow-up is not tailored to the risk of locoregional recurrences in individual patients or as a function of time. The objective of this study was to identify prognostic factors, and to estimate individual and time dependent locoregional recurrence risk rates, in order to tailor follow-up for the individual patient in terms of intensity and duration. Material and Methods: Prognostic factors for locoregional recurrence were identified by a scoping literature review, field expert consultation, and stepwise multivariate regression analysis based on 5-years of population data from the Netherlands Cancer Registry from women diagnosed with breast cancer in the Netherlands in 2005 or 2006 (n = 17762). Inter-patient variability was elucidated by examples of five-year risk profiles of average, medium, and high risk patients, whereby six-month interval risks were derived from regression estimates. Results: Eight prognostic factors were identified: age, tumour size, multifocality, gradation, adjuvant chemo-, adjuvant radiation-, hormonal therapy and triple negative receptor-status. The mutual weights of the contribution to the local regional recurrence risks were determined. Risk S408 Proffered Papers profiles of the low-, average-, and high risk example patients showed nonuniform distribution of recurrence risks (2.9%, 7.6%, and 9.2% respectively over a five year period). Conclusions: Individual risk profiles differ substantially in subgroups of patients defined by prognostic factors for recurrence and over time as defined in six-month time intervals. To tailor follow-up schedules, decrease anxiety in patients and to optimise allocation of scarce resources, risk factors, frequency and duration of follow-up should be taken into account.