What follow-up should women have after surgical treatment of breast cancer?
The best available evidence supports clinical breast examinations every three to six months for five years and annual mammography for asymptomatic breast cancer survivors. More intensive follow-up and subspecialist visits do not improve survival.
Rojas and colleagues identified four studies that compared different approaches to follow-up in 3,055 women who were surgically treated for Stage I, II, or III breast cancer. Two studies (2,563 women) compared a minimal follow-up strategy (i.e., clinical breast examination every three to six months and annual mammography) with more intensive follow-up that included laboratory and imaging tests such as chest radiograph and bone scan in addition to regular examinations. After five to 10 years, the studies found no difference in overall mortality (relative risk [RR], 0.98; 95 percent confidence interval [CI], 0.84 to 1.15) or quality of life between groups. One study found a benefit in disease-free survival in the intensive follow-up group (bone scan and chest radiograph every six months), though the other did not. The pooled RR for disease-free survival for both studies was 0.84 (P = .05; 95 percent CI, 0.71 to 1.00).
One study with 296 women compared hospital-based subspecialist follow-up with follow-up by the patient’s family physician. There was no significant difference in the likelihood of recurrence (7 percent with family physicians versus 11 percent with subspecialists) and patients reported more satisfaction with care from their family physician. A limitation of these studies is their age, but recent evidence-based guidelines are consistent with their findings. The Institute for Clinical Systems Improvement1 and the National Comprehensive Cancer Network2 also recommend clinical breast examinations every four to six months for five years, then annually, with annual mammograms for asymptomatic breast cancer survivors. They do not recommend routine laboratory or imaging studies for asymptomatic women who are not expected to have a recurrence.