Metastatic Presentations of Previously Treated Early-Stage Breast Cancer Patients and Association With Survival

Fear of cancer recurrence is common among breast cancer (BC) survivors. We investigated methods of diagnosing recurrence and their association with survival. Metastatic diagnoses were most commonly made by patient-reported symptoms, and there was no survival difference by diagnostic method, which, we hope, will ease the anxiety experienced by BC patients. Background: Breast cancer (BC) patients undergoing surveillance often fear recurrence. Given that routine imaging is not recommended, recognizing metastatic disease early requires a knowledge of recurrence patterns. The aimof this study was to analyze the most common presentations of metastatic disease. Patients and Methods: A retrospective review was conducted of patients who were initially diagnosed with early-stage BC and who later developed metastatic disease. Data collected included method of metastatic disease diagnosis, types of symptoms at diagnosis, and survival. Chi-square tests as well as logistic and Cox regression models were used. Results: Metastatic diagnoses were made from reported symptoms in 77.6% of patients, clinical examination in 3.2%, and 7.8% incidentally on imaging. Among those with symptoms, musculoskeletal pain was the most common (33.7%) and was more frequently noted at scheduled (48.9%) compared to acute-care visits (26.0%, P < .01). Receptor status was associated with nervous system symptoms at metastasis (P = .01), with higher odds of nervous system symptoms in triple-negative (odds ratio = 3.02) compared to estrogen receptor/progesterone receptorepositive, HER2- cases. On multivariable analysis, initial stage (P =.03), receptor status (P <.01), age (P <.01), and time to recurrence (P <.01) were significantly associated with 10-year survival after diagnosis of metastasis, whereas the presence of symptoms was not (P =.27). Providers of BC patients undergoing surveillance should modify their threshold of suspicion for recurrence depending on the characteristics of the initial diagnosis and the symptoms subsequently reported. Conclusion: In this retrospective study, patients who presented with symptoms did not have shorter survival compared to those who were diagnosed in other ways. (C) 2019 The Author(s). Published by Elsevier Inc.