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Guiding Follow-Up Care in Breast Cancer

Guiding Follow-Up Care in Breast Cancer

In 2006, the American Society of Clinical Oncology (ASCO) issued practice guidelines on the follow-up and management of patients with breast cancer who have completed primary therapy with curative intent. Since that time, ASCO completed a 6-year, systematic review and analysis of 14 publications in an effort to update these guidelines. ASCO reissued the recommendations from 2006 in the Journal of Clinical Oncology and came to the conclusion that no revisions to the existing recommendation were warranted. “An important reason behind re-issuing the guidelines is that physicians and patients aren’t always following the recommendations,” explains Thomas J. Smith, MD, a member of the ASCO writing committee for the guidelines. “It has been estimated that more than $1 billion is spent each year on unnecessary breast cancer follow-up care. By re-issuing the guidelines, it’s hoped that clinicians will make greater efforts to adhere to these recommendations.” Assessing Surveillance Research indicates that routine surveillance with PET, CAT, and bone scans—in addition to routine blood tests—is unwarranted in asymptomatic patients with breast cancer. “Physicians tend to deny that they’re ordering these tests, but studies suggest that, in actuality, many clinicians are ordering these diagnostics,” says Dr. Smith. “However, there are no data to date that suggest these tests are beneficial in the management of asymptomatic patients.” Meanwhile, Dr. Smith says other data suggest that patients and physicians do not always obtain tests that are recommended in the guidelines. “Research clearly indicates that patients should undergo a mammogram on the opposite side after definitive surgery for one breast cancer,” he says. “However, study after study has shown that many patients don’t have a...
Early Detection & Treatment of Breast Cancer

Early Detection & Treatment of Breast Cancer

One in eight women will be diagnosed with breast cancer in their lifetime, and two-thirds of women diagnosed with breast cancer are aged 50 and older. Known risk factors include radiation exposure and never being pregnant or having a first child after age 35. Other risk factors include menopause after age 55, postmenopausal hormone therapy, obesity, and having dense breast tissue. Hereditary factors can also be a cause. BRCA1 and BRCA2 gene mutations account for about 20% to 25% of hereditary breast cancers and about 5% to 10% of all breast cancers. A woman whose mother, sister, or daughter had breast cancer—especially if the cancer was bilateral, pre-menopausal, or occurred in more than one first-degree relative—is two or three times more likely to develop breast cancer. Genetic counseling should be considered for women with this history. Reviewing Recent Data on Breast Cancer Diagnosis-Related Failure A recent review of claims data from The Doctors Company revealed that 92% of breast cancer cases involved a diagnosis-related failure, and about 30% of these cases included misinterpreting a diagnostic test, such as a mammogram or breast biopsy. Research suggests that screening mammograms miss 10% to 20% of breast cancers. A study in the New England Journal of Medicine compared traditional mammograms to digital mammograms and found that the digital screenings were superior for women younger than 50, those with dense breast tissue, and women who were premenopausal or in their first year of menopause. Getting on the Same Page: Beginning Screening Mammography There may be some confusion about when screening mammography should begin because recommendations vary. The American Cancer Society recommends that women...

Assessing Follow-Up Screenings in Childhood Cancer Survivors

Research has shown that women who are treated with chest radiation for a pediatric malignancy have a significantly increased risk of developing breast cancer at a young age. The risk of breast cancer is greatest among female pediatric cancer survivors who have been treated for Hodgkin lymphoma with high-dose mantle radiation. By age 45, it is estimated that 12% to 20% of women treated with moderate-to-high dose chest radiation will be diagnosed with breast cancer. For perspective, women with a BRCA gene mutation have an estimated cumulative incidence of breast cancer that ranges from 1% to 5% at age 30 and from 10% to 19% at age...
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