Medical Surveillance after Primary Treatment of Breast Cancers

After primary treatment of breast cancers (say, surgery, or combination of surgery and chemotherapy, surgery and hormonal therapy, or surgery, chemotherapy and radiation therapy), there is a need to do medical surveillance to closely observe or monitor for persistence or recurrence of the breast cancer.

The question is how should physicians or breast specialists do medical surveillance? Patients often ask this question also.

For the past 30 years or so (since the start of my private practice in 1982 – 34 years in 2016), I have been following the symptom-directed approach of medical surveillance. Symptom-directed approach means that diagnostic tests are done only when there are symptoms suggestive of recurrence such as persistent bone pain (bone metastasis), cough (lung metastasis), headaches (brain metastasis), and abdominal pain (abdominal metastasis).

I don’t recommend the intensive battery of routine diagnostic tests such as chest x-ray; bone scan; ultrasound of the abdomen; CT-scan of the brain; tumor markers; etc.

The reason for preferring symptom-directed approach over the intensive battery of routine diagnostic test in medical surveillance is simple, the results of scientific studies.   Scientific studies have consistently shown no benefit in terms of survival and health-related quality of life.  The other reasons are unnecessary expenses and potential for false-positive results.

http://jama.ama-assn.org/content/271/20/1587.full.pdf

http://jama.ama-assn.org/content/271/20/1593.full.pdf

http://www.ncbi.nlm.nih.gov/pubmed/11034727?dopt=Abstract&holding=npg

https://sites.google.com/site/breastcancersurveillance/current-guidelines-on-breast-cancer-surveillance

In 2012, the American Society of Clinical Oncology updated its guidelines and it shows basically the same approach as symptom-directed.

Breast Cancer Follow-Up and Management After Primary Treatment: American Society of Clinical Oncology Clinical Practice Guideline Update

http://jco.ascopubs.org/content/early/2012/11/05/JCO.2012.45.9859.full.pdf

Recommendations:

Regular history, physical examination, and mammography are recommended for breast cancer follow-up. Physical examinations should be performed every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and annually thereafter.

For women who have undergone breast-conserving surgery, a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy. Thereafter, unless otherwise indicated, a yearly mammographic evaluation should be performed.

The use of complete blood counts, chemistry panels, bone scans, chest radiographs, liver ultrasounds, pelvic ultrasounds, computed tomography scans, [18F]fluorodeoxyglucose–positron emission tomography scans, magnetic resonance imaging, and/or tumor markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is not recommended for routine follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination.

So there you are, symptom-directed approach.

In 2011, I put up a website to serve as a repository of my thought, perception, opinion, and recommendations (TPOR) and collection of articles on BREAST CANCER SURVEILLANCE.  I will try to update this as soon as possible to include the 2012 Breast Cancer Follow-Up and Management After Primary Treatment: American Society of Clinical Oncology Clinical Practice Guideline Update.  Here is the URL:

https://sites.google.com/site/breastcancersurveillance/home

ROJ-TPOR@16oct7

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This entry was posted in Breast Cancer Recurrence, Breast Cancers. Bookmark the permalink.

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