It has now been well established that routine scans are not useful in follow-up care of breast cancer survivors. Guidelines recommend that all patients who have completed primary treatment for breast cancer should have regular follow-up surveillance consisting of medical history, physical examination and annual mammograms. It was also recommended that the frequency of visits be adjusted according to the individual patient’s needs, that patients be encouraged to report new persistent symptoms promptly without waiting for the next scheduled appointment, that the responsibility for follow-up be formally allocated to a single physician and that the patient be fully informed of the arrangements for follow-up.
NICE, the National Institute for Clinical Excellence, responsible for providing UK NHS guidance on treatment, had strongly recommended that routine follow up of such patients in specialist care should be limited to two or three years.
Recurrence of breast cancer is usually symptomatic and is often first noticed by the patient rather than at routine follow-up visits to hospital clinics. Women will frequently report the symptoms first to their GP. A study that compared breast cancer follow-up in primary care with specialist care shows that patients were more satisfied with follow-up in general practice and that there was no increase in time to diagnosis of recurrence in primary care compared with specialist care.
‘Guidelines for limited (two or three years) follow-up should be agreed by each network. The aims of follow-up should be to detect and treat local recurrence and adverse effects of therapy, particularly lymphoedema. Intensive follow-up, designed to detect metastatic disease before symptoms develop, is not beneficial and should not be provided.’( NICE: Improving Outcomes in Breast Cancer: Manual Update 2002)
Eva Grunfeld, Sukhbinder Dhesy-Thind, Mark Levine, CLinical Care Guidelines: follow-up after treatment for breast cancer (summary of the 2005 update) CMAJ • May 10, 2005; 172 (10)
E. Grunfeld, M. N. Levine, and J. A. Julian
J. Clin. Oncol., August 1, 2006; 24(22): 3711 – 3712.
E. Grunfeld, M. N. Levine, J. A. Julian, D. Coyle, B. Szechtman, D. Mirsky, S. Verma, S. Dent, C. Sawka, K. I. Pritchard, D. Ginsburg, M. Wood, and T. Whelan
Randomized Trial of Long-Term Follow-Up for Early-Stage Breast Cancer: A Comparison of Family Physician Versus Specialist Care
J. Clin. Oncol., February 20, 2006; 24(6): 848 – 855.