Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01)

Guidelines for follow-up after locoregional breast cancer treatment recommend imaging for distant metastases only in the presence of patient signs and/or symptoms. However, guidelines have not been updated to reflect advances in imaging, systemic therapy, or the understanding of biological subtype. We assessed the association between mode of distant recurrence detection and survival.In this observational study, a stage-stratified random sample of women with stage II-III breast cancer in 2006-2007 and followed through 2016 was selected, including up to 10 women from each of 1217 Commission on Cancer facilities (n = 10 076). The explanatory variable was mode of recurrence detection (asymptomatic imaging vs signs and/or symptoms). The outcome was time from initial cancer diagnosis to death. Registrars abstracted scan type, intent (cancer-related vs not, asymptomatic surveillance vs not), and recurrence. Data were merged with each patient’s National Cancer Database record.Surveillance imaging detected 23.3\% (284 of 1220) of distant recurrences (76.7\%, 936 of 1220 by signs and/or symptoms). Based on propensity-weighted multivariable Cox proportional hazards models, patients with asymptomatic imaging compared with sign and/or symptom detected recurrences had a lower risk of death if estrogen receptor (ER) and progesterone receptor (PR) negative, HER2 negative (triple negative; hazard ratio [HR] = 0.73, 95\% confidence interval [CI] = 0.54 to 0.99), or HER2 positive (HR = 0.51, 95\% CI = 0.33 to 0.80). No association was observed for ER- or PR-positive, HER2-negative (HR = 1.14, 95\% CI = 0.91 to 1.44) cancers.Recurrence detection by asymptomatic imaging compared with signs and/or symptoms was associated with lower risk of death for triple-negative and HER2-positive, but not ER- or PR-positive, HER2-negative cancers. A randomized trial is warranted to evaluate imaging surveillance for metastases results in these subgroups.



Work Title Surveillance Imaging vs Symptomatic Recurrence Detection and Survival in Stage II-III Breast Cancer (AFT-01)
Open Access
  1. Jessica R Schumacher
  2. Heather B Neuman
  3. Menggang Yu
  4. David J Vanness
  5. Yajuan Si
  6. Elizabeth S Burnside
  7. Kathryn J Ruddy
  8. Ann H Partridge
  9. Deborah Schrag
  10. Stephen B Edge
  11. Ying Zhang
  12. Elizabeth A Jacobs
  13. Jeffrey Havlena
  14. Amanda B Francescatti
  15. David P Winchester
  16. Daniel P McKellar
  17. Patricia A Spears
  18. Benjamin D Kozower
  19. George J Chang
  20. Caprice C Greenberg
  21. for the Alliance ACS-CRP CCDR Breast Cancer Surveillance Working Group
License In Copyright (Rights Reserved)
Work Type Article
  1. JNCI: Journal of the National Cancer Institute
Publication Date August 1, 2022
Publisher Identifier (DOI)
Deposited October 03, 2022




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Work History

Version 1

  • Created
  • Added JNCI-19-1450R1_Schumacher_NIHMS.docx
  • Added Creator Jessica R Schumacher
  • Added Creator Heather B Neuman
  • Added Creator Menggang Yu
  • Added Creator David J Vanness
  • Added Creator Yajuan Si
  • Added Creator Elizabeth S Burnside
  • Added Creator Kathryn J Ruddy
  • Added Creator Ann H Partridge
  • Added Creator Deborah Schrag
  • Added Creator Stephen B Edge
  • Added Creator Ying Zhang
  • Added Creator Elizabeth A Jacobs
  • Added Creator Jeffrey Havlena
  • Added Creator Amanda B Francescatti
  • Added Creator David P Winchester
  • Added Creator Daniel P McKellar
  • Added Creator Patricia A Spears
  • Added Creator Benjamin D Kozower
  • Added Creator George J Chang
  • Added Creator Caprice C Greenberg
  • Added Creator for the Alliance ACS-CRP CCDR Breast Cancer Surveillance Working Group
  • Published
  • Updated