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.

#Arrangoiz #Surgeon #CancerSurgeon #BreastSurgeon #SurgicalOncology #Teacher

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