Imaging Methods for Detecting Metastases

In Germany, a follow-up scheme for patients who have completed breast cancer treatment includes regular check-ups and psychosocial counseling, currently lasting up to 10 years. Another important goal is the early detection of recurrences or metastases. Statistically, the risk of recurrence remains high in the first 5 years and gradually decreases afterward. Overall, recurrences occur in 20% of patients.

Recurrences are classified into local recurrences (in the breast and nearby lymph nodes), tumors in the opposite breast (contralateral tumors), and distant metastases, which can occur in other organs, most often in the bones, liver, or lungs. The good news is that newly developed treatments have significantly improved long-term survival chances for women with metastatic breast cancer.

What can be done to detect recurrences or metastases early?
The fact is that there are no studies to date that confirm the benefits of early detection of metastases. However, some doctors, based on experience, recommend breast MRIs every 2 years. In between, mammography and breast ultrasound can be performed. Annual liver and abdominal ultrasounds, as well as MRIs, provide good diagnostic results without exposure to radiation or other similar factors. Whole-body MRI also offers good visualization for the early detection of metastases.

Currently, participants are being recruited for the SURVIVE study, which aims to scientifically confirm the effectiveness of enhanced monitoring. Through what is called a "liquid biopsy," blood is taken from study participants to detect asymptomatic distant metastases by analyzing tumor markers, circulating tumor cells (CTC), and circulating tumor DNA (ctDNA). If abnormalities are found, imaging is performed. However, it should be noted that liquid biopsy will be conducted only for the first 5 years, not throughout the entire 10-year follow-up period. Nevertheless, it is expected that liquid biopsy will identify reliable markers of metastasis that will also be significant for long-term follow-up.

What can be done now?
Individual monitoring, tailored to personal risks, remains the responsibility of the patients. This will continue until studies prove that early detection of recurrences improves survival outcomes. Regardless, it is crucial for all women undergoing follow-up care to pay close attention to their bodies’ signals. Most importantly, if any symptoms, changes, or concerns arise, an immediate visit to the doctor is essential. The "wait and see" approach is not advisable in this case.

1. S3 Breast Cancer Guideline, Version 4.4, June 2021

2. Patient Guide based on AGO 2023 recommendations, Association of Gynecological Oncology (AGO)