The NBOCC* statements and recommendations for follow-up care in women with early breast cancer are based on an NBOCC* systematic review2 of available evidence from randomised controlled trials and other study designs. Many papers have been published; however, a limited number of studies were identified that were considered high quality evidence, such as randomised controlled trials. Studies that included women who had completed active treatment (surgery, radiotherapy and/or chemotherapy) for early breast cancer which made any comparisons between different kinds of follow-up care were identified. These included methods of detection of recurrence, provider of follow-up care, standard versus intensive follow-up, different frequency or duration of follow-up care and economics of follow-up.
Papers were excluded if they were not investigating follow-up care, defined as routine follow-up for the purpose of detecting recurrence and/or new primary cancer, monitoring side effects of treatment and providing psychosocial care. Standard follow-up procedures include personal history, physical examination and mammography. Additional tests may be performed where clinically indicated. Studies investigating diagnostic follow-up procedures (e.g. use of magnetic resonance imaging (MRI) or positron emission tomography (PET) after clinical suspicion of recurrence) were not included.
Primary studies included in the systematic review were:
- five randomised controlled trials that addressed provider of follow-up care or standard follow-up compared to intensive follow-up
- eight comparative (cohort or case control) studies that examined different methods or providers of follow-up care
- twenty-one observational studies that looked at method of detection of recurrence or patterns of care
- five prognostic studies that examined tumour markers
- twenty-one qualitative studies (surveys, questionnaires, focus groups and interviews) that provided additional information on perceptions of follow-up care and patient needs and preferences.
* 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.