Reassessing the Role of Regular Physical Examination in Post-treatment Breast Cancer Surveillance

BACKGROUND: Routine provider-performed physical examinations remain a standard element of breast cancer survivorship despite increasing evidence that diagnostic yield is limited. With growing survivorship populations and mounting demands on oncology services, reassessment of the value of this practice is warranted. This study sought to evaluate the diagnostic yield and prognostic relevance of surveillance physical exams. METHODS: A retrospective review was conducted of women with breast cancer treated between January 2019 and December 2023 at a single tertiary center. Surgical oncology survivorship visits >90 days postoperatively were analyzed. Recurrence events were categorized by initial detection modality: provider-performed physical examination, patient-reported, screening imaging, or symptom-prompted non-breast imaging. RESULTS: Among 3337 patients, 131 recurrences (3.9%) occurred after a median of 20 months. Patients collectively attended 12,840 survivorship visits; only eight recurrences (6.1% of all recurrences; 0.06% of examinations) were first detected by physical examination. By comparison, 32 (24.4%) were patient-reported, 38 (29.0%) were detected on screening imaging, and 53 (40.5%) were identified by non-breast diagnostic imaging. When stratified by detection method, exam-detected recurrences were evenly divided between locoregional and combined locoregional/distant disease, whereas patient-reported and screening-detected recurrences were predominantly locoregional, at 72% and 92%, respectively. CONCLUSIONS: Breast and chest wall examinations accounted for a small proportion of recurrence detections despite thousands of survivorship visits annually. Most clinically meaningful recurrences were identified by imaging or patient self-report. These findings support survivorship strategies that prioritize imaging adherence and structured symptom assessment, with less emphasis on routine physical examination as a primary detection modality.