Follow-up care of breast cancer survivors
Introduction
Breast cancer is the most common malignancy in American women, accounting for 31% of new cancer cases in women [1]. In 2002, there were an estimated 205 000 new cases of invasive breast cancer and 54 300 cases of in situ breast cancer [1]. With improved screening and early detection of disease, the majority of patients are diagnosed with early stage breast cancer with the hope for long-term cure. Despite these advances, a significant number of people die from breast cancer each year, with an estimated 40 000 deaths from breast cancer in 2002 [1].
The follow-up care of the breast cancer survivor requires an understanding of the short and long term side effects of the breast cancer treatment, the goals of follow-up, and the unique psychological aspects of the care of these patients. In this article, we will discuss the principles of follow-up care of the breast cancer survivor.
Section snippets
Goals of follow-up
An understanding of the goals of follow-up is essential in the care of the breast cancer patient. Patients who are diagnosed with recurrent disease in the breast or a second primary breast cancer are potentially curable with early detection and treatment. Therefore, we perform a thorough search for recurrent disease in the breast or a second primary breast cancer, including patient history and physical examination at regular intervals, mammography, and self-breast examination. At present,
Detection of recurrence in the breast or a second primary tumor
Patients with a history of breast cancer are at risk for a second primary breast cancer in the preserved or contralateral breast or recurrent disease in the affected breast. Both of these are potentially curable. The risk of a second primary breast cancer in the contralateral breast is estimated at 0.5–1.0% per year [4]. Risk factors for the development of contralateral breast cancer include: hereditary breast cancer, familial breast cancer, young age at primary diagnosis, radiation exposure at
The search for metastatic breast cancer: how hard should we look
At present, metastatic breast cancer is not curable. However, it can have a remarkably heterogeneous natural history and some patients succumb quickly to their disease while others live years or even decades after metastases are discovered. Therefore, several studies have focused on the question of whether an intensive search for metastatic disease alters patient survival or quality of life.
Two prospective studies published in JAMA in 1994 addressed this question. The first was a study of 1243
Side effects of the primary treatment of breast cancer
Primary treatment for breast cancer consists of local therapy (surgery and radiation) and systemic therapy (chemotherapy and/or hormonal therapy). The recommendations for follow-up of these patients requires an understanding of the short and long term side effects of treatment.
Psychological impact of breast cancer
The diagnosis of breast cancer has an important psychological impact on both the patient and family. The breast is important symbol of cultural femininity. Loss of the breast and a diagnosis of cancer can be associated with a myriad of feelings including sadness, grief, fear, anxiety, and depression [72]. A study by Maunsell and colleagues examined potential risk factors for psychological distress following initial treatment for breast cancer. They found that patients with a history of
Recommendations for follow-up
Although it is important to be aware of the potential short and long-term side effects of primary treatment for breast cancer, there is no recommended screening tools for these toxicities other than careful history and physical examination, with further tests ordered based on patient symptoms. In order to standardize the recommendations for follow-up care, the American Society of Clinical Oncology Breast Cancer Expert Panel developed breast cancer surveillance guidelines for the care of breast
Conclusions
Breast cancer is a disease that affects thousands of women per year. The majority of these women will be cured of their disease. An understanding of the goals of follow-up is essential in the follow-up care of the breast cancer patient. An emphasis is placed on detection of recurrent disease in the breast or a second primary tumor, which is potentially curable. An exhaustive search for metastatic disease in the asymptomatic patient is not performed as studies have demonstrated that early
Reviewers
Harold J. Burstein, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA.
Angelo Di Leo, Institut Jules Bordet, Chemotherapy unit-Breast Office, Rue Héger Bordet 1, B-1000 Brussels, Belgium.
Dr Charles L. Shapiro, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, B421 Starling-Loving Hall, 320 west 10th Avenue, Columbus, OH 43210, USA.
Dr Arti Hurria is a geriatrician and oncologist, focusing on care of the older cancer patient. She completed an internal medicine residency at Beth Israel Medical Center in Boston in 1998. Following this, Dr Hurria completed a geriatric fellowship in the Harvard Geriatric Fellowship Program, followed by a hematology–oncology fellowship at Memorial Sloan-Kettering Cancer Center. Dr Hurria presently serves a Clinical Assistant Physician on the Breast Cancer Medicine Service at Memorial Sloan
References (75)
- et al.
Evolving perspectives in contralateral breast cancer
Eur. J. Cancer
(1998) Breast cancer screening
Med. Clin. North Am.
(1999)- et al.
Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy
Int. J. Radiat. Oncol. Biol. Phys.
(1986) - et al.
Should women be advised against pregnancy after breast-cancer treatment?
Lancet
(1997) - et al.
Cancer Statistics 2002
CA Cancer J. Clin.
(2002) Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial
J. Am. Med. Assoc.
(1994)- et al.
Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up
J. Am. Med. Assoc.
(1994) - et al.
Primary care for survivors of breast cancer
New Engl. J. Med.
(2000) - American Society of Clinical Oncology. Recommended breast cancer surveillance guidelines. J Clin Oncol...
- et al.
Efficacy of screening mammography. A meta-analysis
J. Am. Med. Assoc.
(1995)
Breast self-examination in relation to the occurrence of advanced breast cancer
J. Natl. Cancer Inst.
Randomized trial of self breast exam in Shangai: methodology and preliminary results
J. Natl. Cancer Inst.
Intensive vs. clinical follow-up after treatment of primary breast cancer: 10-year update of a randomized trial. National Research Council Project on Breast Cancer Follow-up
J. Am. Med. Assoc.
Use of Chemotherapy plus a Monoclonal Antibody against HER2 for Metastatic Breast Cancer That Overexpresses HER2
New Engl. J. Med.
Can we cure limited metastatic breast cancer?
J. Clin. Oncol.
2000 Update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology
J. Clin. Oncol.
Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer
New Engl. J. Med.
The sentinel node in breast cancer—a multicenter validation study
New Engl. J. Med.
Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis
Cancer
Lymphedema after sentinel lymphadenectomy for breast carcinoma
Cancer
Primary care for survivors of breast cancer
New Engl. J. Med.
American Society of Clinical Oncology. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology
J. Clin. Oncol.
Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials
Lancet
Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis
J. Clin. Oncol.
Side effects of adjuvant treatment of breast cancer
New Engl. J. Med.
Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer
J. Clin. Oncol.
Fertility preservation in breast cancer patients: IVF and embryo cryopreservation after ovarian stimulation with tamoxifen
Hum. Reprod.
Ovarian tissue cryopreservation and transplantation: preliminary findings and implications for cancer patients
Hum. Reprod. Update
Influence of prior and subsequent pregnancy on breast cancer prognosis
J. Clin. Oncol.
Pregnancy and offspring after adjuvant chemotherapy in breast cancer patients
Cancer
How subsequent pregnancy affects outcome in women with a prior breast cancer
Oncology (Huntingt)
Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early-stage breast cancer
J. Clin. Oncol.
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Dr Arti Hurria is a geriatrician and oncologist, focusing on care of the older cancer patient. She completed an internal medicine residency at Beth Israel Medical Center in Boston in 1998. Following this, Dr Hurria completed a geriatric fellowship in the Harvard Geriatric Fellowship Program, followed by a hematology–oncology fellowship at Memorial Sloan-Kettering Cancer Center. Dr Hurria presently serves a Clinical Assistant Physician on the Breast Cancer Medicine Service at Memorial Sloan Kettering Cancer Center. Her clinical and research focus is on care of the older breast cancer patient.