LAUSR

Purpose: An important aim of follow-up after primary breast cancer treatment is early detection of locoregional recurrences (LRR) to improve survival. This study proposes and simulates two personalized follow-up schemes based on LRR risk predictions provided by the INFLUENCE-nomogram (a time-dependent prognostic model for breast cancer-LRR) and quantifies their possible follow-up efficiency. Methods: Patients with early breast cancer who received surgery with curative intent between 2003 and 2008 were selected from the Netherlands Cancer Registry. The INFLUENCE-nomogram was used to estimate five annual LRR risks for every patient. Applying two thresholds, defined according to (a) Youden’s J-statistic, and (b) a pre-defined follow-up sensitivity of 95%, these risk estimations served as basis to decide when to schedule follow-up visits; thus, two personalized follow-up schemes were simulated. The number of potentially saved follow-up visits and corresponding cost savings for each follow-up scheme were compared to the current Dutch breast cancer guideline on a training and testing cohort. Results: Using LRR risk predictions for 30,379 Dutch breast cancer patients from 2003 to 2006 (training cohort), two thresholds were calculated. The threshold according to Youden’s approach yielded a follow-up sensitivity of 62.5% and a potential saving of 62.1% of follow-up visits and 24.8 M €. When the threshold corresponding to 95% follow-up sensitivity is used, 17.0% of follow-up visits and 7.0 M € could be saved. Similar results were obtained by applying these thresholds to the testing cohort of 11,462 patients from 2007 to 2008. Conclusion: Personalized follow-up schemes based on the INFLUENCE-nomogram’s individual risk estimations for breast cancer-LRR could decrease the number of follow-up visits if one accepts a limited risk of delayed LRR detection. Citation Format: Teresa Draeger, Vinzenz Voelkel, Catharina GM Groothuis-Oudshoorn, Miha Lavric, Jeroen Veltman, Anneriet Dassen, Lisbeth J. Boersma, Annemieke Witteveen, Gabe S. Sonke, Hendrik Koffijberg, Sabine Siesling. Applying risk-based follow-up strategies on the Dutch breast cancer population: Consequences for care and costs [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-11.