Cancer Treatment Today

The question of how to follow up patients with breast cancer after resection and adjuvant chemotherapy has been addressed by several guidelines. There appears to be little flexibility in being able to approve PET, since guidelines unanimously do not recommend routine CT or PET imaging. Two randomized trials performed in Italy failed to show any impact of intensive diagnostic follow-up on 5-year mortality for patients with primary breast cancer.

ASCO states: “The evidence supports regular history, physical examination, and mammography as the cornerstone of appropriate breast cancer follow-up. All patients should have a careful history and physical examination performed by a physician experienced in the surveillance of cancer patients and in breast examination. 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 those 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. Patients at high risk for familial breast cancer syndromes should be referred for genetic counseling. The use of CBCs, chemistry panels, bone scans, chest radiographs, liver ultrasounds, computed tomography scans, [18F]fluorodeoxyglucose-positron emission tomography scanning, magnetic resonance imaging, or tumor markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is not recommended for routine breast cancer follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination.”

This is also the recommendation of NCCN (does say” consider abdominal or pelvic CT” but not PET), Cochrane and a Canadian guideline.

ASCO 2006 Update of the Breast Cancer Follow-Up and Management Guideline in the Adjuvant Setting J Oncol Pract 2006 2: 317-318

Hayes DF. Clinical practice. Follow-up of patients with early breast cancer. N Engl J Med 2007; 356:2505.

Rojas MP, Telaro E, Russo A, et al. Follow-up strategies for women treated for early breast cancer (Cochrane Review) In : The Cochrane library, vol. 3. Oxford: update Software; 2001

NCCN, Breast Cancer, 2012.
Hayes DF. Clinical practice. Follow-up of patients with early breast cancer. N Engl J Med 2007; 356:2505.

JCO Prepub, 2011 – http://jco.ascopubs.org/content/early/2012/03/05/JCO.2011.40.6975.full.pdf