Recommended Breast Cancer Surveillance
History, Physical Examination, and Patient Education Regarding Symptoms of Recurrence
2006 recommendation. All women should have a careful history and physical examination every 3 to 6 months for the first 3 years after primary therapy, then every 6 to 12 months for the next 2 years, and then annually. Physicians should counsel patients about the symptoms of recurrence including new lumps, bone pain, chest pain, dyspnea, abdominal pain, or persistent headaches. Helpful Web sites for patient education include www.plwc.org and www.cancer.org.
Women at high risk for familial breast cancer syndromes should be referred for genetic counseling in accordance with clinical guidelines recommended by the U.S. Preventive Services Task Force (USPSTF) (see the National Guideline Clearinghouse [NGC] summary of the USPSTF guideline Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: recommendation statement). Criteria to recommend referral include the following: Ashkenazi Jewish heritage; history of ovarian cancer at any age in the patient or any first- or second-degree relatives; any first-degree relative with a history of breast cancer diagnosed before the age of 50 years; two or more first- or second-degree relatives diagnosed with breast cancer at any age; patient or relative with diagnosis of bilateral breast cancer; and history of breast cancer in a male relative.
Breast Self-Examination
2006 recommendation. All women should be counseled to perform monthly breast self-examination (BSE).
Mammography
2006 recommendation. Women treated with breast-conserving therapy should have their first post-treatment mammogram no earlier than 6 months after definitive radiation therapy. Subsequent mammograms should be obtained every 6 to 12 months for surveillance of abnormalities. Mammography should be performed yearly if stability of mammographic findings is achieved after completion of locoregional therapy.
Coordination of Care
2006 recommendation. The risk of breast cancer recurrence continues through 15 years after primary treatment and beyond. Continuity of care for breast cancer patients is recommended and should be performed by a physician experienced in the surveillance of cancer patients and in breast examination, including the examination of irradiated breasts.
Follow-up by a primary care physician (PCP) seems to lead to the same health outcomes as specialist follow-up with good patient satisfaction. If a patient with early-stage breast cancer (tumor <5 cm and < four positive nodes) desires follow-up exclusively by a PCP, care may be transferred to the PCP approximately 1 year after diagnosis. If care is transferred to a PCP, both the PCP and the patient should be informed of the appropriate follow-up and management strategy. This approach will necessitate referral for oncology assessment if a patient is receiving adjuvant endocrine therapy.
Pelvic Examination
2006 recommendation. Regular gynecologic follow-up is recommended for all women. Patients who receive tamoxifen therapy are at increased risk for developing endometrial cancer and should be advised to report any vaginal bleeding to their physicians. Longer follow-up intervals may be appropriate for women who have had a total hysterectomy and oophorectomy.
Breast Cancer Surveillance Testing: Not Recommended
Complete Blood Count (CBC)
2006 recommendation. CBC testing is not recommended for routine breast cancer surveillance.
Automated Chemistry Studies
2006 recommendation. Automated chemistry studies are not recommended for routine breast cancer surveillance.
Chest X-Rays
2006 recommendation. Chest x-rays are not recommended for routine breast cancer surveillance.
Bone Scan
2006 recommendation. Bone scans are not recommended for routine breast cancer surveillance.
Ultrasound of the Liver
2006 recommendation. Liver ultrasound is not recommended for routine breast cancer surveillance.
Computed Tomography (CT)
2006 recommendation. CT is not recommended for routine breast cancer surveillance.
[18F]Fluorodeoxyglucose–Positron Emission Tomography Scanning
2006 recommendation. [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning is not recommended for routine breast cancer surveillance.
Breast Magnetic Resonance Imaging
2006 recommendation. Breast magnetic resonance imaging (MRI) is not recommended for routine breast cancer surveillance.
Breast Cancer Tumor Markers CA 15-3 and CA 27.29
2006 recommendation. The use of the CA 15-3 or CA 27.29 is not recommended for routine surveillance of breast cancer patients after primary therapy. The ASCO Breast Cancer Tumor Markers Panel will publish guideline recommendations for selected tumor markers.
Breast Cancer Tumor Marker Carcinoembryonic Antigen
2006 recommendation. Carcinoembryonic antigen testing is not recommended for routine surveillance of breast cancer patients after primary therapy. The ASCO Breast Cancer Tumor Markers Panel will publish guideline recommendations for selected tumor markers.
