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This article is part of the supplement: Royal College of Radiologists Breast Group Annual Scientific Meeting 2010

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Surveillance following breast cancer: is it cost-effective?

L Ternent12*, G MacLennan1, SD Heys34, F Gilbert45, L Vale12 and Mammographic Surveillance HTA Group

  • * Corresponding author: L Ternent

Author Affiliations

1 Health Services Research Unit, University of Aberdeen, UK

2 Health Economics Research Unit, University of Aberdeen, UK

3 Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen, UK

4 Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK

5 Aberdeen Biomedical Imaging Centre, University of Aberdeen, UK

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Breast Cancer Research 2010, 12(Suppl 3):P5  doi:10.1186/bcr2658

The electronic version of this article is the complete one and can be found online at:

Published:25 October 2010

© 2010 Ternent et al; licensee BioMed Central Ltd.


There is debate about the role and optimal organisation of follow-up following treatment for primary breast cancer. We estimated using the best available evidence whether early detection by surveillance of ipsilateral breast tumour recurrence (IBTR) and metachronous contralateral breast cancer (MCBC) was cost-effective.


An economic model compared alternative surveillance strategies involving mammographic surveillance and/or clinical follow-up performed at differing surveillance intervals. The model structure was based upon discussions with the clinical experts involved in the study, a survey of UK breast surgeons and radiologists, and the literature. Data to populate the model came from a series of systematic reviews and an analysis of the West Midlands Cancer Intelligence Unit Breast Cancer Registry. Results of the model were presented as incremental cost per QALYs - a measure of relative efficiency.


The surveillance strategy most likely to be cost-effective was mammographic surveillance alone provided every 12 to 24 months. This result held for women who had previously received either breast-conserving surgery or mastectomy. Results were sensitive to primary tumour characteristics (size, grade, nodal involvement) used to define the likelihoods of developing an IBTR or MCBC. More intensive follow-up of women with higher likelihood of developing IBTR or MCBC may be worthwhile.


Our conclusions remain tentative due to the paucity of the underlying evidence base but suggest surveillance is likely to improve survival, with a strategy of mammography alone every 12 to 24 months appearing cost-effective.