title: Non-surgical management of early breast cancer in the United Kingdom: follow-up. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology.
abstract: Follow-up of operable breast cancer patients takes up a significant proportion of British oncologists' time, with 90% seeing 5-50 patients each week. Procedures vary greatly, but, in patients treated by surgery and radiotherapy, care is usually shared, with alternating visits to see each team. Currently, the general practitioner has sole responsibility for follow-up in less than 3% of patients. They tend to be followed up in general, rather than specialist, clinics. There is almost universal agreement that routine blood tests, radiographs and scans are not indicated as part of routine follow-up, but the role of mammography in evaluating an irradiated breast remains a source of debate. Just over a half of the oncologists surveyed order baseline mammography of both treated and contralateral breasts, usually between 6 and 12 months after local excision and radiotherapy, with further follow-up 1-3-yearly thereafter. Ten per cent of the participating oncologists never suggest follow-up mammography. Patients tend to be followed in oncology clinics at 3-4-monthly intervals for the first 2 years, 6-monthly in the third and fourth years and, thereafter, yearly. Fifteen per cent of oncologists discharge patients at 5 years, with the discharge rate rising to 43% at 10 years; around one-third modify follow-up according to the age of the patient. The aims of follow-up were seen to include detection of curable disease, but other goals were perceived as equally important (e.g. detection of iatrogenic problems, audit, counselling, education and the provision of early palliation of incurable and metastatic disease. Breast cancer is no longer seen as an absolute contraindication to either pregnancy or the use of hormone replacement therapy (HRT); however, oncologists are uncertain about the appropriate use of HRT, either alone or with tamoxifen. This audit highlights a number of research areas: the identification of the appropriate site and skill-mix for follow-up of patients; clarification of the aims and attitudes to follow-up by both patients and health care professionals; the use of breast imaging; and the role of HRT.
authors.affiliation: Mount Vernon Centre for Cancer Treatment, Northwood, UK.
authors.forename: E J
authors.initials: EJ
authors.lastname: Maher
mesh_terms: D000367:Age Factors; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002173:Cancer Care Facilities; D019411:Clinical Laboratory Techniques; D003376:Counseling; D004965:Estrogen Antagonists / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008327:Mammography; D008485:Medical Audit; D008495:Medical Oncology; D008875:Middle Aged; D010166:Palliative Care; D010348:Patient Care Team; D010351:Patient Discharge; D010353:Patient Education as Topic; D011247:Pregnancy; D013629:Tamoxifen / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D018931:Antineoplastic Agents, Hormonal; D004965:Estrogen Antagonists; D013629:Tamoxifen