Objective: To determine the efficiency of surveillance among women with a high risk of breast cancer by semiannual breast examination and annual mammography.
Setting: 'Dr. Daniel den Hoed' Cancer Centre, Rotterdam, the Netherlands.
Design: Retrospective study.
Method: In 1994 breast cancer was diagnosed in 92 patients: in 19 patients during surveillance (SU), in 48 referred because of symptoms (SY) and in 25 during the national screening programme (SC). The contributions of physical examination, mammography, ultrasound and fine needle aspiration cytology to the diagnosis were evaluated and the tumour stages in the 3 groups were compared.
Results: The mean age was 53 years in the SU group, 51 years in the SY group and 64 years in the SC group. Breast cancer was detected by mammography only in 6%, 40% and 42% in the SY, SC and SU groups, respectively. 42% of patients had a family history of breast cancer in the SU group. Mammography failed to reveal malignancy in 25% of patients in the SU and SY groups combined. In women in the SU group 53% of breast cancers were: carcinoma in situ (Tis) or minimal invasive carcinoma (< 0.5 cm diameter; T1a). In patients with a family history of breast cancer 75% (6/8) were diagnosed in stages Tis or T1a, by surveillance. In the SY group 4% were Tis or T1a and 40% N1 + 2, in the SC group 8% and 20% respectively. 15.7% of the SU group had axillary lymph node metastases (N1) but only one of the 8 patients with a family history of breast cancer.
Conclusions: Surveillance by palpation and mammography in women with a high risk of breast cancer is useful, because it detects this disease frequently at an early stage, when the prognosis is still good.