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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...
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