Follow-up of Patients with Early Breast Cancer

ArticleinNew England Journal of Medicine 356(24):2505-13 · July 2007with3 Reads
DOI: 10.1056/NEJMcp067260 · Source: PubMed
An otherwise healthy 53-year-old woman is seen for routine care after completing treatment several months earlier for stage II estrogen-receptor- positive, HER2-positive breast cancer. The treatment consisted of lumpectomy, irradiation, adjuvant chemotherapy (doxorubicin and cyclophosphamide followed by paclitaxel), and trastuzumab. Her only current medication is an aromatase inhibitor. She is amenorrheic. She reports fatigue, hot flashes, arthralgias, and sexual difficulties and is concerned about the risk of a recurrence. How would you follow this patient, and what would you recommend for her symptoms?
    • "Although breast cancer occurs most often in women over the age of 50, several reports have been published suggesting an increase in the incidence and mortality in young women in different world populations [6]. In young women breast cancer is the leading cause of death in both western and developing countries [7], representing 5% to 7% of cases in some series [8]. Studies suggest that early breast cancer differs from breast cancer in the usual age, regarding etiology, tumor behavior, and prognosis [9][10][11][12]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective. To investigate and compare aspects of breast cancer in young women (<40 years old) with older women (>40 years old). Methods. Retrospective, cross-sectional, analytical, and exploratory study based on data from 2009 to 2012 obtained from the Breast Cancer Information System (SISMAMA) and the Unified Health System Information Data (DATASUS). The studied population consisted of women () with malignant breast cancer. The analysed variables were education level, race, nodule detection at the clinical examination or image studies, presence of palpable axillary lymph nodes, surgical approach, and tumor histological type and grade. Results. There was increasing detection of breast cancer cases in young women among the studied years. Young women had more palpable lymph nodes (OR 1.28, 95% CI: 1.18–1.39), ductal carcinoma as the most frequent histologic type (OR 1.36, 95% CI: 1.22 to 1.53), and grades II and III tumor (OR 16.01 , 95% CI: 13.30 to 19.28 ). The lesion detection by clinical examination was higher in women <40 years (OR 1.34, 95% CI: 1.24 to 1.45). Conclusion. Although there are early detection measures related to breast cancer, they are not the usual practice of the young female public, suggesting the need for a review of existing public policies in the country.
    Full-text · Article · May 2014
    • "Breast cancer surveillance procedures after primary treatment are common practice in clinical oncology even if their methodology is still a controversial issue. The primary aim of breast cancer follow-up is to decrease mortality and improve well-being through early detection of second ipsi-or contralateral cancer and local recurrences, which are potentially curable, and ascertainment of symptoms suggestive of metastatic disease [1]. On the other hand, detection of metastatic disease in asymptomatic patients by intensive surveillance including complete blood counts, chemistry panels, tumor markers, imaging modalities (i.e. "
    [Show abstract] [Hide abstract] ABSTRACT: Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called "tailored follow-up", high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time.
    Full-text · Article · Apr 2014
    • "Issues related to body image are common and may have a substantial impact on sexuality [84]. Fatigue and cognitive dysfunction are also common in breast cancer survivors [23] and are particularly challenging to manage. "
    [Show abstract] [Hide abstract] ABSTRACT: Breast cancer, the most common cancer in women in developed countries, has a generally excellent prognosis, therefore long-term survivors living with the consequences of breast cancer ('survivors') and its treatment are an increasing group in clinical practice. This review discusses the complex issues relevant to survivorship care, including current recommendations for ongoing adjuvant hormonal therapy (tamoxifen and aromatase inhibitors), and the management of side effects of cancer treatment (such as menopause, arthralgia, and lymphoedema). Annual mammography screening is advised for detection of second breast cancers, and symptom-directed assessment is warranted where there is suspicion of distant recurrence or (in women using tamoxifen) of endometrial cancer. Management of menopausal symptoms, including treatment-induced premature menopause, is a key issue for many survivors, and can be challenging to manage as conventional hormone replacement therapy is contraindicated in most of these women. Specific therapeutic options for hot flushes and vaginal symptoms are discussed. The review also emphasises the need for survivorship care to include optimisation of general health, including psychosocial and sexual health, bone health and the evaluation of lifestyle-related risk factors and genetic factors. The review provides guidance on the management of many of these issues, and highlights areas requiring further evidence and research.
    Article · Jun 2011
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