Follow-up of Patients With Breast Cancer

To the Editor. —The studies published recently by the GIVIO Investigators 1 and by Rosselli Del Turco et al 2 are timely and well intended. However, the conclusions drawn by the investigators might be misleading. The conclusion reached by the GIVIO group is that the health-related quality of life of breast cancer patients was the same whether follow-up examinations were performed with or without imaging procedures and laboratory tests. This conclusion was based on responses to questionnaires; 68% (901 of 1320) at 1 year, and 60% (639 of 1066 survivors) at the fifth year. Forty percent of the subjects did not respond to the questionnaires or were not included in the fifth-year survey. What if those nonresponders in the fifth year have a completely different sense of well-being? Patients with breast cancer in the early stages, similar to the subjects in the two studies, may show a disease-free survival of