Previous randomized trials, performed decades ago, showed no survival benefit of intensive screening for distant
metastasis in
breast cancer. However, recent improvements in targeted
therapies and diagnostic accuracy of imaging have again raised the question of the clinical benefit of screening for distant
metastasis. Therefore, we investigated the association between the use of modern imaging and survival of patients with
breast cancer who eventually developed distant
metastasis. We retrospectively reviewed data of 398 patients who developed distant
metastasis after their initial curative treatment between January 2000 and December 2015. Patients in the less-intensive surveillance group (LSG) had significantly longer relapse-free survival than did patients in the intensive surveillance group (ISG) (8.7 vs. 22.8 months; p = 0.002). While the ISG showed worse overall survival than the LSG did (50.2 vs. 59.9 months; p = 0.015), the difference was insignificant after adjusting for other prognostic factors. Among the 225 asymptomatic patients whose
metastases were detected on imaging, the intensity of screening did not affect overall survival. A small subgroup of patients showed poor survival outcomes when they underwent intensive screening. Patients with HR-/HER2 + tumors and patients who developed lung
metastasis in the LSG had better overall survival than those in the ISG did. Highly intensive screening for distant
metastasis in disease-free patients with
breast cancer was not associated with significant survival benefits, despite the recent improvements in therapeutic options and diagnostic techniques.