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Follow up After Breast Cancer Treatment

Posted 4/17/2014

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  This is a second (a bonus?) blog for today. Tomorrow we are traveling to Maine to open our beloved cottage for the season, and I know it will be hard to find time to make the daily entry. One real uncertainty is whether the internet will be working when we get there; it is never very good, but, after a long and hard winter, it is may be completely messed up. If that is the case, I will be back to a library visit to write the blog, and I know that won't happen tomorrow.

  This second topic today is follow up for women after adjuvant breast cancer treatment. Over the years of my employment, standard follow up has changed a great deal. Thirty years ago, women had annual bone scans and chest x-rays, in addition to a lot of blood work, after treatment ended. Perhaps five years later, the bone scans were stopped unless there was a specific concern; the annual chest x-rays continued until about fifteen years ago. Now, the ASCO recommendations are simple: annual mammograms (and perhaps annual breast MRIs for women at high risk) and an appointment with your doctor for a conversation and an exam. That's it. If you are interested in their guidelines: http://www.asco.org/quality-guidelines/breast-cancer-follow-and-management-after-primary-treatment-american-society

  This article is from Critical Reviews in Oncology and Hematology and reports on an Italian study that summarized recent studies and recommendations. Again, the bottom line is that an annual mammogram and clinical exam are all that is needed--unless there is suspicion of a problem. One rarely discussed reality is that much of the time, a woman becomes aware of a worry before she comes to the doctor. Cancer that spreads, that metastisizes, will declare itself.

  Here is the citation and the conclusions and a link to read the whole article:

Follow-up of patients with early breast cancer: Is it time to rewrite the story?
Fabio Puglisi a,b,∗, Caterina Fontanella a, Gianmauro Numicoc, Valentina Sini d,
Laura Evangelista e, Francesco Monetti f, Stefania Gori g, Lucia Del Mastro

 Conclusions
Outside from the experimental setting there is currently no
reason to perform any examination in asymptomatic patients
other than annual mammography: no single imaging modality
has the required characteristics of sensitivity, specificity
and cost-effectiveness ratio to be considered suitable for BC
follow-up. Intensive surveillance is associated with falsepositive
findings, induction of anxiety, risk of exposure to
radiation, and unjustified costs. Information of patients and
education of physicians should be pursued. However, the biological
knowledge and the management improvement should
be considered the basis for a renewed interest of research
in the field of follow-up. Are probably definitively gone the
times of a “one size fits all” strategy: BC is a heterogeneous
disease and different approaches should be adapted to the different
disease subtypes. The combination of the best current
diagnostic tools with the best therapies may demonstrate that
the anticipation of relapse detection and treatment is worth
of value in specific settings. This research is eagerly awaited.

http://dx.doi.org/10.1016/j.critrevonc.2014.03.001

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