One test or twenty? The follow-up of cancer survivors

This study examined the use of low-intensity and high-intensity surveillance schedules in the follow-up of breast cancer survivors.

The number of women diagnosed with breast cancer rises every year. However, breast cancer treatments have also improved dramatically in recent decades, and mortality rates are declining. This has led to a large number of breast cancer survivors. Since breast cancer may recur after treatments, usually within the first few years, these cured patients still need to undergo long-term surveillance in order to detect signs of cancer recurrence.  The current guidelines recommend that breast cancer survivors undergo a low-intensity surveillance schedule. This includes a physical examination and interval history every 4-6 months for the first 5 years after treatments, with a mammography (breast X-ray) performed every 12 months (first mammography should be performed within 6 months of last treatment). Following the first 5 years, examination and interval history is recommended once yearly.

A low-intensity surveillance schedule is recommended since most studies performed to date have found that more intensive surveillance, such as frequent chest X-rays or liver scans for the early detection of metastatic recurrence (return of the cancer in distant organs), does not necessarily increase survival rates. However, few studies have examined the actual surveillance practices used by the treating oncologists.

The current study surveyed practicing oncologists to determine whether the guidelines for surveillance schedules were followed in a real-life setting. Participating oncologists were asked to describe the surveillance schedules they would use for a variety of fictional patients.

The most commonly used surveillance methods chosen by oncologists were office visits, mammographies and lab tests (such as a complete blood count or liver function tests).  Despite the current guidelines, many physicians chose a more intense surveillance schedule for patients at a higher risk for recurrence (such as patients with extensive lymph node involvement). Many oncologists recommended a medical assessment of cancer survivors every 3 months for the first 5 years following treatment.

This study concluded that despite current evidence, surveillance of breast cancer survivors is often more intense than is recommended by the standard guidelines.

Since current evidence suggests that high-intensity surveillance does not improve survival, this increased follow-up intensity may be the cause of unnecessary emotional stress and a heavy financial burden for cancer survivors.

Consult with your physician regarding the risk of cancer recurrence and the surveillance schedule that is most suited for your condition.