The American Society of Clinical Oncology recently published the results of its most current guidelines for follow-up care of women who completed treatment for primary breast cancer. The 2012 findings, published online in the Journal of Clinical Oncology in November, determined that no change to the existing guidelines is necessary.
ASCO’s clinical practice guideline recommends best-practices for breast cancer care and management based on evidence from newly published cancer research. It was originally released in 1997, and previously updated in 1999 and 2006.
How the Recommendations Were Reviewed
An update committee of medical professionals who work in the academic and community setting was created to review research published between March 2006 and March 2012, housed in the U.S. National Library of Medicine’s MEDLINE and the Cochrane Collaboration Library. The committee included medical oncologists; a surgical, radiation, hematologic and gynecologic oncologist; a primary care doctor; and a patient advocate.
The studies analyzed focused on follow-up care and management for women who completed primary treatment. They considered breast cancer-free survival, overall survival, health-related quality of life, reduced side effects and cost effectiveness. Randomized controlled trials (RCTs) comparing specific treatment methods among participants randomly assigned to different treatment groups, systematic reviews summarizing results of several similar studies into one report, and clinical practice guidelines recommending certain treatments or care were considered for inclusion.
Results of the Review
The results of the studies examined, along with studies that had unreliable results, sample sizes or methods, led the update committee to determine no changes need to be made to the ASCO clinical practice guidelines for follow-up care for primary breast cancer.
Of the 14 articles included, none focused on history or physical breast exams, breast self-exams, education on symptoms of recurrence, referral for genetic counseling, or breast cancer tumor marker testing.
The usefulness of some breast imaging techniques, frequency of appointments and cost-effectiveness were explored in several systematic reviews and in one meta-analysis. The quality of these studies and meta-analyses, the characteristics of participants and the study designs differed greatly among those analyzed.
Five RCTs evaluated models of care for surveillance practices. These studies varied in quality, population size, follow-up period and treatments prescribed, making their results hard to deem reliable. Other studies did not provide enough information on the method of research, or concluded that alternative care plans did not impact the outcome of follow-up care.
The committee also found that the current ASCO recommendations differ slightly in frequency and duration of follow-up from other clinical guidelines, but most are similar to those recommended by ASCO.
What This Means for You
ASCO’s current guideline, which will remain the same, recommends you receive:
- Regular history, physical exams every three to six months for the first three years after treatment, every six to 12 months during years four and five, and once a year after six years
- Education on symptoms of recurrence and performing monthly self-exams
- Referral for genetic counseling if you are at high risk
- After lumpectomy, a mammogram one year after the initial mammogram and at least six months after radiation therapy ends, with a mammogram once a year from that point on
- Regular gynecologic follow-up
- Care from an oncology specialist for one year following treatment, before returning to a primary care doctor for continued follow-up
Methods not recommended for regular follow-up care in the absence of symptoms of recurrence are:
- Complete blood count (CBC)
- Chemistry panels
- Imaging: bone scans, chest radiographs, liver ultrasounds, CT scans, MRIs, PET scans
- Tumor marker tests
Getting to know these recommendations may help you understand and manage your breast cancer care moving forward. Talk with your doctor about these recommendations, a survivorship care plan and any concerns you have when planning your follow-up care.
Khatcheressian, James L., Hurley, Patricia, et al: Breast Cancer Follow-Up and Management After Primary Treatment: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol (2012)30. Online: 5 November 2012.