Results and recommendations for surveillance/follow-up of breast cancer undergoing adjuvant hormonotherapy.

Abstract

e23179 Background: We conducted a 10-year retrospective review to design post-treatment monitoring plans for breast cancer patients receiving endocrine therapy at our hospital. Methods: Data from breast cancer patients treated with adjuvant hormonotherapy (Tamoxifen or aromatase inhibitors) between January 2014 and December 2023 at Medic Centers, Đức Khang Hospital, and Vạn Hạnh Hospital in Ho Chi Minh City were analyzed. The evaluation focused on follow-up efficacy, monitoring plans, and side effects, including vaginal discharge, fatty liver, elevated cholesterol, triglycerides, glucosemia, liver and kidney function, cardiovascular function, recurrence time, disease-free survival, and overall survival. Results: The study included 1262 cases (1256 females, 6 males) with breast cancer stages I to III. The median age was 42 years (range 23-82). 75% used Tamoxifen, 10% switched to AI after 2-5 years of Tamoxifen,17.3% used AI. The average menopause age was 51.5 years. Recurrence occurred in 25% of cases, with an 18.9% mortality rate. Common symptoms included joint pain and fatigue (90%), increased vaginal discharge (65%), and itching from allergies (3%). Tamoxifen was changed or discontinued due to allergic reactions or excessive vaginal discharge (4%). Routine examinations detected 4% of recurrences/metastases: US: Fatty liver (92.3%), endometrial thickening (35%), liver nodules (6.5%), liver metastasis (3.7%), peritoneal carcinomatosis (1.4%), renal metastasis (0.01%), pleural effusion (0.05%), chest wall recurrence (8.6%), cervical lymph nodes (7%), heart failure (0.5%). Chest X-ray: Lung metastasis (0.4%), post-radiation pulmonary fibrosis (4.4%). Annual mammography: Contralateral breast cancer detection (1.4%). Bone density measurement: Osteoporosis with T score <=-2.5 to -1 (32%). Blood tests: Elevated: liver enzymes (15%) primarily in the first 2 years (90%), Creatinine (1%), cholesterol (42%),triglycerides (56%), glucosemia (18%), CA 15.3 levels more than normal with no recurrence/metastasis detected (24%). 21% of cases were detected through emergency or unexpected tests (US, CT scan, MRI, PET/CT) prompted by patient-reported symptoms like palpable masses, lymph nodes, pain, cough, headache, toothache, abdominal distension, and fatigue. Conclusions: Over 10 years, the recurrence/metastasis rate was 25%, and the mortality rate was 18.9%. Routine examinations identified 4% of cases, with the rest detected between scheduled visits due to patient-reported issues. These examinations revealed treatment-related adverse effects and complications, such as fatty liver, endometrial thickening, elevated liver enzymes, and osteoporosis.