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Breast Cancer Does Not Need High-Tech Follow-Up

The 2006 ASCO guidelines emphasize history, physical exams, genetic counseling, breast self-exams, mammography, coordination of care, and patient education.

The American Society of Clinical Oncology (ASCO) has updated its 1998 guidelines on breast cancer follow-up. Periodic history taking, physical exams, and patient education about symptoms of recurrence remain key factors in breast cancer surveillance. Genetic counseling is recommended for high-risk women, including those with Ashkenazi Jewish heritage, family history of breast or ovarian cancer, or diagnosis of bilateral breast cancer in the patient or a relative. All women should perform monthly breast self-exams. Women who have had breast-conserving treatment should have mammograms starting 1 year after diagnosis (but no earlier than 6 months after radiation treatment) and annually thereafter. Routine pelvic exams are recommended, and any vaginal bleeding in women taking tamoxifen should be promptly investigated.

Study results have shown no survival advantage or improvement in quality of life for intensive compared with conservative surveillance. Thus, complete blood counts (CBCs) and liver function tests, imaging studies, and assessment of tumor markers are not recommended for routine surveillance. Although magnetic resonance imaging and [¹⁸F]fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning both appear useful in diagnosing recurrent breast cancer, data are insufficient to support the use of either method for routine surveillance in asymptomatic patients.

Comment: Because breast cancer can recur within 15 years of the initial diagnosis and beyond, surveillance is a lifelong process. Coordination of care between the primary care physician (PCP) and specialist is recommended. For a woman with early-stage breast cancer (<5-cm tumor and <4 positive nodes), care can be transferred to the PCP 1 year after diagnosis, provided both patient and PCP are informed about appropriate surveillance. Follow-up by a PCP rather than a specialist has been shown to have the same health outcomes with equal or better patient satisfaction. Unfortunately, however, who follows the patient might not matter: 69% of symptomatic recurrences develop between scheduled exams.

— Wendy S. Biggs, MD

Published in Journal Watch Women's Health December 14, 2006

Citation(s):

Khatcheressian JL et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol 2006 Nov 1; 24:5091-7.

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