title: Surveillance and monitoring in breast cancer survivors: maximizing benefit and minimizing harm.
abstract: Although the incidence of breast cancer has increased, breast cancer mortality has decreased, likely as a result of both breast cancer screening and improved treatment. There are well over two million breast cancer survivors in the United States for whom appropriate surveillance continues to be a subject of controversy. The guidelines from the American Society of Clinical Oncology (ASCO) and the American College of Physicians are clear: only performance of yearly screening mammography is supported by evidence. Although advanced imaging technologies and sophisticated circulating tumor biomarker studies are exquisitely sensitive for the detection of recurrent breast cancer, there is no proof that earlier detection of metastases will improve outcome. A lack of specificity may lead to more tests and patient anxiety. Many breast cancer survivors are not followed by oncologists, and their doctors may not be familiar with these recommendations. Oncologists also disregard the data. A plethora of both blood tests and nonmammographic imaging tests are frequently performed in asymptomatic women. The blood tests, marker studies, and advanced imaging techniques are expensive and, with limited health care funds, may prevent funding for more appropriate aspects of patient care. Abnormal marker studies lead to additional imaging procedures. Repeated CT scans and radionuclide imaging may induce a second cancer because of the radiation dose, and invasive procedures performed as a result of these examinations also add risk to patients without clear benefits. Improved adherence to the current guidelines can cut costs, reduce risks, and improve patient quality of life without adversely affecting outcome.
authors.affiliation: From the Memorial Sloan-Kettering Cancer Center, New York, NY; University of Michigan Medical Center, Ann Arbor, MI; Schools of Medicine and Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Maxine
authors.initials: M
authors.lastname: Jochelson
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hayes
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D001943:Breast Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003266:Continuity of Patient Care; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005189:False Positive Reactions; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008134:Long-Term Care; D008327:Mammography / Q000191:economics / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor