Postoperative follow-up of breast-cancer patients: Screening for asymptomatic metastases

Periodic follow-up for the early detection of distant metastases is a common practice, Although follow-up is mainly aimed at improving prognosis through early treatment of early detected asymptomatic metastases, its efficacy has never been proven, The common clinical finding that less extensive metastatic disease is associated with better survival after their detection is simply explained by the lead-time bias, and length-biased sampling may account for the few retrospective studies reporting a better survival from primary treatment for asymptomatic vs, symptomatic metastases, On the contrary, most retrospective studies show no prognostic impact of the follow-up procedure, Recently, two Italian randomized studies comparing minimal vs, intensive follow-up regimens, confirmed that early detection and treatment of distant metastases have no impact on prognosis, Screening for distant metastases should still be a matter of research, testing new methods and regimens, but based on the scientific evidence presently available, there is no reason to recommend periodic screening for distant metastases as a routine procedure, as costs and side-effects are considerable, and no benefits are proven.