Routine Surveillance Following Breast Cancer Treatment

• As part of routine surveillance of patients diagnosed with breast cancer, the following is recommended according to the NCCN guidelines:
  • History and physical exam:
    • 1 to 4 times per year:
      • As clinically appropriate, for 5 years, and then annually
  • Educate, monitor, and refer for lymphedema management
  • Mammography every year
  • In the absence of symptoms:
    • There is no evidence to support laboratory or imaging studies:
      • For metastatic screening
  • Women on tamoxifen:
    • Should have annual gynecologic screening
  • Women on aromatase inhibitor therapy:
    • Should have monitoring of bone health and density at baseline and periodically thereafter
  • Assess and encourage adherence to adjuvant endocrine therapy
  • Evidence suggests that active lifestyle and achieving and maintaining an ideal body weight (20 to 25 BMI):
    • May lead to optimal breast cancer outcomes
• The American Society of Clinical Oncology (ASCO) and the American Cancer Society convened a multidisciplinary expert panel and published:
  • The Breast Cancer Survivorship Care Guidelines in 2016
  • A multidisciplinary panel that included primary care, gynecology, surgical oncology, medical oncology, and radiation oncology physicians in conjunction with nursing agreed upon these guidelines
  • Together, they reviewed more than 1000 articles and ultimately included 237 of them as the basis for their recommendations
  • In essence, their conclusions mirror those in the current NCCN guidelines:
    • Supporting regular surveillance for breast cancer recurrence, which includes a:
      • Cancer-related history and physical examination
      • Routine imaging screening with mammography for new primary breast cancer
      • The panel agrees routine laboratory or additional imaging is not necessary in asymptomatic patients to evaluate for recurrence
      • The panel stresses the importance of maintaining a healthy lifestyle

REFERENCES

1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines for Oncology: Breast Cancer. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp Published January 2016. Accessed January 29, 2017.
2. Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol. 2016;34(6):611-635.

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