Breast cancer posttreatment surveillance: diagnosis and management of recurrent disease.

Invasive breast cancer is the most common malignancy diagnosed in American women. The use of screening mammography and progress in adjuvant therapy has led to a steady decline in breast cancer mortality, and as the number of breast cancer survivors increases, there has been a marked increase in the number of patients enrolled in posttreatment surveillance programs.The majority of breast cancer recurrences occurs during the first decade after initial diagnosis with a peak incidence 2 to 5 years after diagnosis, although the number of recurrences for endocrine responsive cancer continues to rise afterward. The goal of posttreatment follow-up programs in patients with breast cancer is to detect potentially curable locoregional recurrences, second primary tumors, and the detection of systemic relapses. However, contrary to the long-held belief, most recurrences are symptomatic and occur during the interval between scheduled visits.