BMJ 2008;336:107-108 (19 January),
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More than 1.2 million women and men worldwide are diagnosed with breast cancer each year. In 2007, the 20 year survival rate for breast cancer will be greater than the five year survival rate 30 years ago.
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Breast cancer is now recognised as a chronic disease that can recur even after 20-30 years. Follow-up protocols vary widely—both within and between countries—and are not always evidence based.
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Guidelines from the National Institute for Health and Clinical Excellence (NICE) in England and Wales state that the aims of breast cancer follow-up are to detect and treat local recurrence, to deal with adverse effects of treatment, and to provide psychological support. Routine surveillance for metastatic disease is not recommended.
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The incidence of metastatic disease peaks around two to three years after diagnosis and stays at 2% annually for up to five years before decreasing.
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The NICE guidelines need urgent revision as they do not meet their stated aims. Clinical examination should be annual for two years. Any unit performing more regular clinical assessments should consider amending their protocols now.
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Psychological support should be available and focused when patients’ needs are greatest—not only at diagnosis and during treatment but after treatment ends.
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Our audit data support annual mammograms.
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Timely investigation of symptoms and communication of test results to patients and primary care doctors will help reduce anxiety and improve ongoing care.
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Patients’ needs vary, so follow-up programmes for patients with breast cancer need to be evidence based, flexible, and tailored to their lifelong needs.
By Mr J M Dixon, consultant surgeon and senior lecturer in surgery, Edinburgh.
