To the Editor.
—Two articles recently published in The Journal1,2 indicate that conservative follow-up (ie, history and physical examinations every 3 months and mammography once a year) for patients with operable breast cancer is as good as a more intensive and expensive approach that would include periodic chest radiography, bone scanning, and in one study, liver ultrasonography. Overall survival and quality of life did not differ between the two types of follow-up. Disease-free survival was shorter in one study with intensive monitoring as a result of earlier detection of metastasis. Overall, the conclusions reached by the authors are supported by the findings.However, I believe that several issues should be considered that may undermine the universality of these conclusions. The findings reported in these two randomized trials are not surprising, since at present, chemotherapy and hormonal therapy for metastatic breast carcinoma are palliative, and therefore, it is unlikely that
Cocconi G. Follow-up of Patients With Breast Cancer. JAMA. 1994;272(21):1657-1658. doi:10.1001/jama.1994.03520210041022