Follow Up 101: An Interview
I have written several times about the important topic of routine follow up after adjuvant breast cancer treatment. Although there are some differences among doctors' approaches, almost all women are surprised by how little testing is done. The core of follow up care remains annual mammogram (and breast MRI when appropriate), and a physical exam and consultation with your doctor once or twice a year. Why not more? What about those blood markers? Scans?
This is an excellent transcript, from a teleconference of Living Beyond Breast CancerLiving Beyond Breast Cancer's November teleconference, Follow-Up Testing 101, featured Nancy U. Lin, MD, of the Dana-Farber Cancer Institute. Listen to a podcast of this teleconference to get practical information about follow-up testing, including:
- The National Cancer Institute's guidelines for follow-up testing
- Why follow-up care may vary from doctor to doctor
- The differences in follow-up care between early-stage and advanced breast cancer
- The importance of a long-term survivorship plan
- How to communicate post-treatment concerns with your doctor
Here is a quote to get you interested and then a link to read more:
…One of the key questions is: Why aren't routine scans or blood tests recommended? It seems that it would make sense to do that, and to look for recurrences early. So, why are they not done? They are not done primarily because of the two large studies that enrolled over a thousand women, the [GIVIO trial] …[http://annonc.oxfordjournals.org/cgi/content/abstract/6/suppl_2/S41] and the [Marco Rosselli Del Turco] study [http://jama.amaassn.org/cgi/content/abstract/271/20/1593?ijkey=e9c304e4faed4ebafc2690166c975498d376136b&keytype2=tf_ipsecsha]. Basically, the way that the studies worked is that women volunteered…and then they were randomly assigned by a computer to either … be in the control group, which … [included] follow-up … as we described before — physical exam, annual mammogram, review of symptoms - [or they were assigned to] …the intensive group. The intensive group … had liver-function tests, chest x-rays, bone scans [and] liver ultrasounds. So, they really had much more intensive screening. Unfortunately, what was found was that, if you follow these women over time, there was absolutely no difference in survival between the two groups; meaning that the women who had all of the intensive tests lived not a day longer than the women who did not have all the intensive tests. And you may ask the next logical question … is: "Why not — why don't routine body-scans and blood-tests work?"