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Recommendations for follow-up of women with early breast cancer

Statements of evidence

STATEMENTS 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
Breast cancer recurrence or new primary or contralateral breast cancers may be self-detected or detected by breast imaging or clinical examination Montgomery4
de Bock5
Some recurrences are detected at routine appointments while others are detected when patients present with symptoms between appointments IV Donnelly6
Hiramanek7
de Bock5
Clinical breast examination and mammography can identify asymptomatic recurrences IV Perrone8
te Boekhorst9
Donnelly6
Ipsilateral breast cancer recurrences detected by mammography have better overall survival compared with those detected by clinical breast examination alone IV Montgomery10
Contralateral breast cancers detected by mammography have better prognostic characteristics (tumour size, lower grade and lymph node status) and overall survival* compared with those detected by clinical breast examination alone IV Kollias11
*Robinson12
Kaas13
No primary studies were identified which addressed the use of ultrasound, PET or MRI in routine follow-up care
Interval and duration of follow-up
No primary studies were identified which addressed how long follow-up care should continue after diagnosis or treatment
Increased frequency of follow-up does not improve disease free survival or overall survival IV
II
Kaas13
Kokko14
Treatment-related side effects may occur long after completion of active treatment
Follow-up care provider
The profession of the health professional who is responsible for follow-up care does not influence survival outcomes or psychosocial or quality of life outcomes* II *Grunfeld15
*Koinberg16
*Brown17
*Koinberg18
The health professional who is responsible for follow-up care may include a medical oncologist, radiation oncologist, surgeon, breast care nurse and general practitioner (GP) NBCC1 **
For multidisciplinary follow-up to be effective, good communication and effective referral options between team members is required NBCC19 **
Not every clinician involved in the treatment of a woman will be closely involved in her follow-up NBCC1 **
Psychosocial care and quality of life
Psychosocial issues, anxiety and depression are common following diagnosis and treatment for breast cancer and individual needs may change over time. Appropriate referral may alleviate depression and anxiety I NBCC20 **
Follow-up care includes managing the expectations of women and empowering them to request or seek what they need I NBCC21 **
Some women may find regular checkups psychologically reassuring^ and/or associate them with increased anxiety IV NBCC21 **
McCaughan22
^Kelly23 Beaver24
^Gaudine25 Allen26
Jiwa27 Renton28
Pennery29
Intensity of follow-up
Intensive follow-up, such as chest X-ray, bone scan, computed tomography (CT), PET or MRI scans, and/or blood tests including full blood count, biochemistry or tumour markers, does not confer any survival benefit or increase in quality of life compared to a standard follow-up schdedule I Rojas30

** 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.

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