American Society of Clinical Oncology 2006 Update of the Breast Cancer Follow-Up and Management Guidelines in the Adjuvant Setting

Johns Hopkins University, Baltimore, Maryland, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 12/2006; 24(31):5091-7. DOI: 10.1200/JCO.2006.08.8575
Source: PubMed


To update the 1999 American Society of Clinical Oncology (ASCO) guideline on breast cancer follow-up and management in the adjuvant setting.
An ASCO Expert Panel reviewed pertinent information from the literature through March 2006. More weight was given to studies that tested a hypothesis directly relating testing to one of the primary outcomes in a randomized design.
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.
Careful history taking, physical examination, and regular mammography are recommended for appropriate detection of breast cancer recurrence.

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    • "The post-treatment follow-up care of BCSs requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care, such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of the care for these patients.7 Further, there are well-established guidelines by the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), the National Institute for Health and Care Excellence (NICE), and other national and international agencies that provide recommendations for key elements of follow-up care for BCSs.8–12 These guidelines aim to assist HCPs with decision-making for the effective management of BCSs, thereby improving patient outcomes. "
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    ABSTRACT: Background: Appropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs) and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of care for these patients. The objective of this systematic review was to identify studies focusing on follow-up care in BCSs from the patient's and physician's perspective or from patterns of care and to integrate primary empirical evidence on the different aspects of follow-up care from these studies. Methods: A comprehensive literature review and evaluation was conducted for all relevant publications in English from January 1, 1990 to December 31, 2013 using electronic databases. Studies were included in the final review if they focused on BCS’s preferences and perceptions, physician's perceptions, patterns of care, and effectiveness of follow-up care. Results: A total of 47 studies assessing the different aspects of follow-up care were included in the review, with a majority of studies (n=13) evaluating the pattern of follow-up care in BCSs, followed by studies focusing on BCS's perceptions (n=9) and preferences (n=9). Most of the studies reported variations in recommended frequency, duration, and intensity of follow-up care as well as frequency of mammogram screening. In addition, variations were noted in patient preferences for type of health care provider (specialist versus non-specialist). Further, BCSs perceived a lack of psychosocial support and information for management of side effects. Conclusion: The studies reviewed, conducted in a range of settings, reflect variations in different aspects of follow-up care. Further, this review also provides useful insight into the unique concerns and needs of BCSs for follow-up care. Thus, clinicians and decision-makers need to understand BCS’s preferences in providing appropriate follow-up care tailored specifically for each patient.
    Patient Related Outcome Measures 08/2014; 5:71-85. DOI:10.2147/PROM.S49586
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    • "Follow-up care of patients after completion of initial treatment is needed to monitor for possible recurrences, long-term side effects of treatments [12], and development of second primary malignancies (eg, breast, cervical, ovarian, and colon) [65], and to optimize overall physical and emotional health [65] [66]. Follow-up frequency and intensity should reflect underlying patient risk factors [12] [66]. Intervals between visits, length of follow-up period, providers responsible for follow-up, and investigations performed at each follow-up visit should be based on individual patient profiles [67]. "
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    ABSTRACT: Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care.
    Breast (Edinburgh, Scotland) 09/2013; 22(5). DOI:10.1016/j.breast.2013.07.049 · 2.38 Impact Factor
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    • "ASCO guideline emphasizes on physical examination and history and minimize the role of CXR and marker in asymptomatic patients [12].Whatever a follow-up program and its frequency is, it should include medical history, physical examination, and annual (in postmenopausal) or at least every 1-2 year mammography(for premenopausal group). It should aim at early detection of loco-regional recurrences or contralateral breast cancer, then psychological support to return the patient normal life, and then to work [13]. "
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    ABSTRACT: Background The beginning of metastasis poorly affects the prognosis of breastcancer patients. Lung is the most frequent site of visceral metastasis, and the rate of recurrence is 10-30%. We have tried to find out if the routine Chest X Ray (CXR) could play a role for early detection of lung metastasis, during the prognosis of these patients. Methods The files of the breast cancer patients between 1996 to 2006 (1739 patients) have reviewed. Clinical characteristics of patients with pulmonary metastasis have recorded. Patients, who lacked imaging files or lacked an appropriate follow-up, have excluded. Data have analyzed by SPSS 11.5. The survival analyses have performed by using the Kaplan-Meier method. Results Fifty-six patients, median age 46, have entered into this retrospective study. Median tumor size was 4cm; median number of Lymphadenopathy (LAP) was 4. The intermediate grade has detected in 74% of patients. All patients have received adjuvant treatment. Median time from cancer diagnosis to pulmonary metastasis was 22 months. Pulmonary metastasis has detected by control CXR in77.4% and patients' symptoms in 22.6%. Forty eight patients have received chemotherapy in metastatic phase. In 28 patients (50%), other sites of metastasis (bone, liver, and brain) have discovered.The most frequent pattern of lung recurrence was pulmonary nodule (44.6%), followed by pleural effusion (28.6%). Median survival was 27.5; median survival from pulmonary metastasis was 8 m. Conclusion Early detection of pulmonary metastasis by CXR did not affect patients' endpoints. None of the probable prognostic factors have shown a significant effect on patients' outcome. Despite systemic treatment, survival after metastasis is low.
    Iranian Journal of Cancer Prevention 03/2013; 6(1):17-24.
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