Practice 12
Not appropriate to perform intensive testing (full blood count, biochemistry or tumour markers) or imaging (chest X-ray, PET, CT and radionuclide bone scans) as part of standard follow-up of patients who have been treated for early breast cancer and who are not experiencing symptoms.
Context
Following completion of active treatment, the long term follow-up of patients with early breast cancer is recommended, a key aim of which is to enable the early detection of any cancer recurrence or new primary breast cancer.
National and international guidelines for the standard follow-up of patients with early breast cancer recommend a standard follow-up schedule of tests and timings, including taking a patient history, clinical examination and annual imaging by mammography and/or ultrasound, with additional tests only if clinically indicated.
Several studies and clinical trials have shown that more intensive follow-up involving chest X-rays, bone scans, CT or PET scans, and/or blood tests including full blood count, biochemistry or tumour markers, does not confer any survival benefit or increase the quality of life of asymptomatic patients treated for early breast cancer compared to a standard follow-up schedule.
Value to patients
Unnecessary imaging and testing increases the potential for a false positive result, and can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, misdiagnosis and unnecessary anxiety.
Supporting evidence
Cancer Australia. Recommendations for follow-up of women with early breast cancer: A clinical practice guideline. 2010. Surry Hills, NSW.
Khatcheressian JL, Hurley P, Bantug E, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology. 2013 Mar 1;31(7):961-5.
Rojas MP, Telaro E, Russo A, et al. Follow-up strategies for women treated for early breast cancer. Cochrane Database Systematic Reviews. 2005 Jan 25;(1):CD001768.
Shah M, Denlinger CS. Optimal post-treatment surveillance in cancer survivors: is more really better? Oncology (Williston Park). 2015 Apr;29(4):230-40.
Simos D, Catley C, van Walraven C, et al. Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study. Canadian Medical Association Journal. 2015 Sep 8;187(12):E387-97.