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
|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
|Mammography should be performed annually to detect ipsilateral recurrence† or new primary, or contralateral breast cancer*||IV||†Montgomery10
|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
|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.
|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.
Where women are being treated in clinical trials, the follow-up schedule may differ from standard recommendations.
|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.
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.