Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisMore recent evidence does not change recommendations for mammograms and other forms of patient care after primary treatment of breast cancer
Khatcheressian J, Hurley P, Bantuget E, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:961-65.
Review question
Do recommendations on the follow up after treatment of breast cancer need updating?
Background
In 1997, the American Society of Clinical Oncology (ASCO) published evidence-based guidelines on the follow up of patients who had been treated for breast cancer.
Clinical practice guidelines are best-practice recommendations for doctors. They focus on the diagnosis and treatment of various diseases. They are recommendations but do not replace the doctor’s professional judgment.
ASCO previously updated its guidelines in 1999 and 2006.
Practice guidelines are also available from other national and international organizations.
How the review was done
This summary is based on a review of 14 new publications by the ASCO Update Committee.
They included 9 systematic reviews and 5 randomized controlled trials published between March 2006 and March 2012.
Outcomes were breast cancer-free survival, overall survival, health quality of life, reduced side effects, and cost effectiveness of follow-up visits and testing.
The purpose was to determine whether the 2006 ASCO guidelines needed updating.
What the researchers found
No need to update any of the 2006 recommendations:
Regular history, physical exam, and mammography for breast cancer follow up
| When | How often |
| Years 1 to 3 | Every 3 to 6 months |
| Years 4 to 5 | Every 6 to 12 months |
| After that | Annually |
After breast-conserving surgery, mammograms should be done
| 1 year after the initial mammogram OR |
| At least 6 months after completing radiation |
| Annually after that |
Tests NOT recommended for regular follow-up care if no reappearing symptoms
| Full blood work (chemistry panel) |
| Bone scans and chest x-rays |
| Liver and pelvic ultrasounds |
| Ct scans, pet scans, and MRIs |
| Tumor marker tests |
Conclusion
New evidence does not change recommendations from the 2006 ASCO guidelines for follow up and management after the first treatment of breast cancer.
Glossary
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
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Related Web Resources
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Breast cancer: Risks and benefits, age 50-69
Canadian Task Force on Preventive Health CareYour risk of dying from breast cancer is slightly reduced if you have regular screening. However, regular screening increases your chance of a false positive result, a biopsy and having part or all of a breast removed unnecessarily. -
Breast cancer: Patient algorithm
Canadian Task Force on Preventive Health CareThe Canadian Task Force on Preventive Health Care recommends women between 50 and 74 years old who are not at high risk get screened for breast cancer every 2 to 3 years. Talk to your doctor about screening options if you are at high risk or over 74 years old. -
Breast cancer: Patient FAQ
Canadian Task Force on Preventive Health CareThis resource includes frequently asked questions about breast cancer, including: Who is considered high risk? What are the harms associated with mammography? and Why is routine screening NOT recommended for women 40-49 years?
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