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Recommendations for follow-up of women with early breast cancer

Clinical practice recommendations

Many factors influence the individual woman’s requirements for follow-up care. Recommendations to individuals should be based on the absolute benefits and potential risks of follow-up care, and the individual’s needs. These factors should be discussed with the woman.

RECOMMENDATIONS LEVEL OF EVIDENCE3 REFERENCE
In women who have completed active treatment for early breast cancer:
Method of detection of recurrence, new primary or contralateral breast cancer
A history should be taken at each follow-up visit for symptoms of locoregional or systemic relapse, long-term treatment-related side effects or psychosocial distress IV Montgomery4
de Bock5
At each follow-up visit clinical examination should be performed. This includes the breast(s) or chest wall, regional lymph nodes and the arm on the treated side. Where appropriate, the examination may also include other organs such as the liver and lungs IV Montgomery4
de Bock5
Mammography should be performed annually to detect ipsilateral recurrence† or new primary, or contralateral breast cancer* IV †Montgomery10
*Kollias11
*Robinson12
*Kaas13
Ultrasound may be used in addition to mammography when indicated on clinical or radiological grounds    
The routine use of PET or MRI is not recommended as part of follow-up. However, the use of MRI may be considered in specific high risk groups    
Women should be advised that between visits they should be aware of the normal look and feel of their breasts, and if changes are detected, to make immediate contact with their GP or the health professional identified as responsible for their follow-up care IV Montgomery4
de Bock5
Interval and duration of follow-up
A standard follow-up schedule is recommended (see NBOCC** recommended follow-up schedule) I Rojas30
Patient history and clinical examination should occur every 3-6 months for the first 2 years, every 6-12 months for the next 3 years and annually after 5 years IV Montgomery4
Mammography (and ultrasound if indicated) should be conducted annually following breast cancer diagnosis IV Montgomery4
There is no evidence to indicate the optimal duration of follow-up. This should be discussed between the patient and the health professionals involved in the woman’s care    
Intensity of follow-up
Intensive follow-up, such as chest X-ray, bone scan, CT, PET or MRI scan, tests including full blood count, biochemistry or tumour markers, are not part of standard follow-up and are recommended only if clinically indicated I Rojas30
Follow-up care provider
The selection of the provider of follow-up care should be a decision made by the multidisciplinary team and the woman, and be based on the purpose of follow-up and the individual woman’s needs. This decision should be reviewed over time    
The multidisciplinary team, including the GP and the woman should be informed of the health professional(s) designated to provide follow-up care, and the schedule for follow-up   NBCC19 **
A patient-held follow-up schedule should be provided to assist with coordination of the patient care plan   NICE31
Psychosocial care and quality of life
The provider of follow-up care should assess psychosocial distress, the impact of the disease and its treatment, and provide appropriate support and referral   NBCC20 **
Other follow-up considerations  

Other disease, treatment and patient factors may influence the requirements for follow-up and should be considered.

These include:

  • long-term hormonal therapy
  • age and hormonal status
  • genetic factors
  • accessibility of services
  • clinical trial participation or data collection and audit
  • long-term effects of systemic therapy
  • side effects of active treatment such as secondary lymphoedema
  • patient preference
  • co-morbidities and their management
  • management of interval presentation for investigation of symptoms
  • bone health
  • sexuality and body image
  • fertility
  • advice about lifestyle factors which may reduce risk of recurrence
When sufficient evidence does not exist to guide definitive recommendations for follow-up, patients should, if possible, be offered entry into clinical trials

** In February 2008, National Breast Cancer Centre (NBCC), incorporating the Ovarian Cancer Program, changed its name to National Breast and Ovarian Cancer Centre (NBOCC). In July 2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.

NBOCC** Recommended follow-up schedule

Where women are being treated in clinical trials, the follow-up schedule may differ from standard recommendations.

NBOCC** RECOMMENDED FOLLOW-UP SCHEDULE  
Method Years 1 and 2 Years 3-5 After 5 Years
History and clinical examination Every 3 – 6 months Every 6 – 12 months Every 12 months
Mammography (and ultrasound if indicated) Every 12 months* Every 12 months Every 12 months
Chest X-ray, bone scan, CT, PET or MRI scans, full blood count, biochemistry and tumour markers Only if clinically indicated on suspicion of recurrence

* First mammogram 12 months post diagnosis
† Use of MRI may be considered in specific high-risk groups
** In July 2011, National Breast and Ovarian Cancer Centre (NBOCC) amalgamated with Cancer Australia to form a single national agency, Cancer Australia, to provide leadership in cancer control and improve outcomes for Australians affected by cancer.



Notes: 
Not every clinician involved in the treatment of a woman will be closely involved in her follow-up. Symptoms should be assessed as they arise.
The interval of follow-up care will depend on patient, tumour and treatment factors.

Published using CeCC Docbook Manager