title: Promoting quality and evidence-based care in early-stage breast cancer follow-up.
abstract: Evidence-based guidelines for long-term follow-up of early-stage breast cancer patients developed by oncology societies in the United States and Europe recommend that breast cancer survivors undergo regular evaluation with history and physical examination, as well as annual mammography. Routine blood tests, circulating tumor markers, and/or surveillance imaging studies beyond mammography are not recommended in the absence of concerning symptoms or physical examination findings because of lack of supportive clinical evidence. Despite these guidelines, studies have shown that 20% to 40% of oncologists assess serum tumor markers as part of routine monitoring of early-stage breast cancer patients. As part of efforts to both address the financial challenges confronting the health-care system and optimize patient outcomes, the American Society of Clinical Oncology's Cost of Care Task Force identified adherence to breast cancer surveillance guidelines as an opportunity to improve care and reduce cost. However, these recommendations are based on trials done in an era of outdated technology and limited therapeutic options. It is possible that recent improvements in diagnostics and treatments could make earlier detection of recurrent disease important for improving both survival and quality of life outcomes. Research is necessary to further inform optimal breast cancer follow-up strategies, which could impact these recommendations. At this time, outside of well-conducted clinical trials, there is no role for ordering routine serial blood or imaging tests in monitoring for recurrence in early-stage breast cancer patients.
authors.forename: N Lynn
authors.initials: NL
authors.lastname: Henry
authors.affiliation: Affiliations of authors: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (NLH, DFH); Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA (SDR, JRG); Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (GNH); Department of Biostatistics, University of Washington, Seattle, WA (WEB).
authors.forename: Lynn N
authors.initials: LN
authors.lastname: Henry
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hayes
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gralow
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods*; D005060:Europe; D019317:Evidence-Based Medicine; D005189:False Positive Reactions; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008327:Mammography; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013997:Time Factors; D014481:United States
chemical_list: D014408:Biomarkers, Tumor