Intensive monitoring of asymptomatic women after treatment for early breast cancer doesn’t improve survival
Intensive monitoring of asymptomatic women after treatment for early breast cancer doesn’t improve survival or quality of life, guidelines from Cancer Australia stress.
Specifically, imaging such as chest x-ray, PET, CT and bone scans should not be recommended as part of standard long-term follow-up, nor should blood tests such as FBC, biochemistry or tumour markers, the guidelines said.
Rather than being beneficial, unnecessary imaging and testing increased the risk of false positives and could harm the patient via invasive procedures, overtreatment and unnecessary radiation, the group warned.
The recommendation was released for Pink Ribbon Day alongside another 11 policies in the Cancer Australia’s push to improve breast cancer practice.
Professor Helen Zorbas, CEO of Cancer Australia, said while the overall standard of care in Australia was high, the standard of care for women with breast cancer varied throughout the country.
“Patients are at the centre of our efforts to maximise clinical benefit, minimise harm and deliver patient-centred care,” she said.
“The statement encourages health professionals to reflect on their clinical practice to ensure it is aligned with the evidence and delivers appropriate care for individual patients,” she said.
Another area highlighted in the guideline was ensuring the triple test was used to confirm or exclude a diagnosis of breast cancer in women presenting with a breast symptom.
The triple test comprises patient history and clinical examination, diagnostic imaging and a non-surgical biopsy.
The new guidelines also recommend that premenopausal women should have the opportunity to discuss fertility and family planning before undergoing treatment, as well as the potential for preserving fertility for future childbearing.
The RACGP said the guidelines were a great reminder of the absolute and essential role of the GP as the main coordinator of breast cancer care.
“Many trials on breast cancer care have shown that GP-led follow up is a safe and effective alternative to sub-specialist follow up RACGP president Dr Bastian Seidel said.
“There is no difference in survival outcomes, or breast cancer recurrences.”
“The Cancer Australia Statement emphasises that access to a GP is more convenient for patients and reduces the need to attend subspecialist follow up in a hospital setting.”
Other recommendations:
- Offer genetic counselling to women with a high familial risk at or around the time that they are diagnosed with breast cancer, with a view to genetic testing to inform decision making about treatment.
- Ensure optimal fixation of breast cancer specimens for accurate pathological examination and biomarker assessment.
- Offer a choice of either breast conserving surgery followed by radiotherapy, or a mastectomy to patients diagnosed with early breast cancer, as these treatments are equally effective in terms of survival.
- Offer a shorter, more intense course of radiotherapy (hypofractionated radiotherapy) as an alternative to conventional radiotherapy for patients with early breast cancer who:
o are aged 50 years and over;
o have a cancer at an early pathological stage (T1-2, N0, M0);
o and have undergone breast conserving surgery with clear surgical margins.
- Offer patients with early breast cancer the opportunity for their follow-up care to be shared between a primary care physician and a specialist, to provide more accessible, whole-person care.
- Offer palliative care early in the management of patients with symptomatic, metastatic breast cancer to improve symptom control and quality of life.
- Consider the pre-operative use of chemotherapy or hormonal therapy (systemic, neo-adjuvant therapy) informed by hormone and HER2 receptor status, for all patients where these therapies are clinically indicated.
- Do not offer a sentinel node biopsy to patients diagnosed with DCIS (ductal carcinoma in situ) having breast conserving surgery, unless clinically indicated.
- Do not perform a mastectomy without first discussing with the patient the options of immediate or delayed breast reconstruction.
For more information, visit the Cancer Australia statement
