Follow-up of breast cancer: why is it necessary to start a Consensus in 2024?
DOI:
https://doi.org/10.33393/ao.2024.2634Keywords:
Consensus, Early breast cancer, Follow-up, Mini-Delphi methodologyAbstract
In Italy, breast cancer is the most frequently diagnosed cancer in women, with 55,900 new cases in 2023 (over 90% in the early stages). Due to the screening, early diagnosis and adjuvant treatment, these patients have a 5-years survival rate of 87% after the diagnosis.
There are 834,154 women in Italy with a previous diagnosis of breast cancer: most of these women require a follow-up.
The AIOM, ESMO and ASCO Guidelines recommend for early breast cancer (EBC) a clinical follow-up with only physical examination (and eliciting of symptoms) and an annual X-ray mammography, on the basis of the results of two randomized trials published in 1994 that showed no benefit in overall survival with intensive follow-up.
However, an Italian survey reported the application by 80% of oncologists of an intensive follow-up based on the individual patient’s risk of recurrence. In fact, the oncologists believe that an early diagnosis of locoregional or distant recurrence may allow an early start of very effective therapies.
In this lack of up-to-date scientific data, many questions about follow-up remain unanswered and the few ongoing studies will provide results in several years.
Non-compliance with guideline recommendations leads to increased costs for the healthcare system. Furthermore, management varies widely from centre to centre with regard to guideline recommendations, resulting in inequalities between patients. For these reasons, the follow-up of breast cancer should be reconsidered.
In the absence of recent scientific evidence, a multidisciplinary group of breast cancer experts has initiated a Consensus on the follow-up of EBC according to the mini-Delphi methodology. The project will be completed by the end of 2024.
Downloads
References
I numeri del canaro in Italia 2023. https://www.aiom.it/i-numeri-del-cancro-in-italia/ (Accessed January 10, 2024)
I numeri del cancro in Italia 2020. https://www.aiom.it/wp-content/uploads/2020/10/2020_Numeri_Cancro-operatori_web.pdf. (Accessed June 22, 2023)
Pan H, Gray R, Braybrooke J, et al; EBCTCG. 20-year risks of breast cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med. 2017;377(19):1836-1846. https://doi.org/10.1056/NEJMoa1701830 PMID:29117498 DOI: https://doi.org/10.1056/NEJMoa1701830
Saphner T, Tormey DC, Gray R. Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol. 1996;14(10):2738-2746. https://doi.org/10.1200/JCO.1996.14.10.2738 PMID:8874335 DOI: https://doi.org/10.1200/JCO.1996.14.10.2738
Linee guida AIOM Carcinoma Mammario in Stadio Precoce. Edizione 2023. https://www.iss.it/documents/20126/8403839/LG_C0013_AIOM_Ca-mammario-precoce.pdf/fb5df1bd-2712-9166-68e7-6e296912776e?t=1704702928747. (Accessed January 10, 2024)
Loibl S, André F, Bachelot T. et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology (2023). https://doi.org/10.1016/j.annonc.2023.11.016. (Accessed Juanuary 10, 2024) DOI: https://doi.org/10.1016/j.annonc.2023.11.016
Khatcheressian JL, Hurley P, Bantug E, et al; American Society of Clinical Oncology. Breast cancer follow-up and management after primary treatment: american Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961-965. https://doi.org/10.1200/JCO.2012.45.9859 PMID:23129741 DOI: https://doi.org/10.1200/JCO.2012.45.9859
Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology breast Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol. 2016;34(6):611-635. https://doi.org/10.1200/JCO.2015.64.3809 PMID:26644543 DOI: https://doi.org/10.1200/JCO.2015.64.3809
de Bock GH, Bonnema J, van der Hage J, Kievit J, van de Velde CJ. Effectiveness of routine visits and routine tests in detecting isolated locoregional recurrences after treatment for early-stage invasive breast cancer: a meta-analysis and systematic review. J Clin Oncol. 2004;22(19):4010-4018. https://doi.org/10.1200/JCO.2004.06.080 PMID:15459225 DOI: https://doi.org/10.1200/JCO.2004.06.080
Montgomery DA, Krupa K, Cooke TG. Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature. Br J Cancer. 2007;97(12):1632-1641. https://doi.org/10.1038/sj.bjc.6604065 PMID:18000508 DOI: https://doi.org/10.1038/sj.bjc.6604065
Lu W, de Bock GH, Schaapveld M, Baas PC, Wiggers T, Jansen L. The value of routine physical examination in the follow up of women with a history of early breast cancer. Eur J Cancer. 2011;47(5):676-682. https://doi.org/10.1016/j.ejca.2010.11.006 PMID:21130643 DOI: https://doi.org/10.1016/j.ejca.2010.11.006
Montgomery DA, Krupa K, Cooke TG. Alternative methods of follow up in breast cancer: a systematic review of the literature. Br J Cancer. 2007;96(11):1625-1632. https://doi.org/10.1038/sj.bjc.6603771 PMID:17486134 DOI: https://doi.org/10.1038/sj.bjc.6603771
Loomer L, Brockschmidt JK, Muss HB, Saylor G. Postoperative follow-up of patients with early breast cancer. Patterns of care among clinical oncologists and a review of the literature. Cancer. 1991;67(1):55-60. https://doi.org/10.1002/1097-0142(19910101)67:1<55::AID-CNCR2820670111>3.0.CO;2-N PMID:1985723 DOI: https://doi.org/10.1002/1097-0142(19910101)67:1<55::AID-CNCR2820670111>3.0.CO;2-N
Pace BW, Tinker MA. Follow-up of patients with breast cancer. Clin Obstet Gynecol. 1994;37(4):998-1002. https://doi.org/10.1097/00003081-199412000-00028 PMID:7842569 DOI: https://doi.org/10.1097/00003081-199412000-00028
Temple LK, Wang EE, McLeod RS. Preventive health care, 1999 update: 3. Follow-up after breast cancer. Canadian Task Force on Preventive Health Care. CMAJ. 1999;161(8):1001-1008. PMID:10551200
Lash TL, Fox MP, Buist DS, et al. Mammography surveillance and mortality in older breast cancer survivors. J Clin Oncol. 2007;25(21):3001-3006. https://doi.org/10.1200/JCO.2006.09.9572 PMID:17548838 DOI: https://doi.org/10.1200/JCO.2006.09.9572
Schootman M, Jeffe DB, Lian M, Aft R, Gillanders WE. Surveillance mammography and the risk of death among elderly breast cancer patients. Breast Cancer Res Treat. 2008;111(3):489-496. https://doi.org/10.1007/s10549-007-9795-1 PMID:17957465 DOI: https://doi.org/10.1007/s10549-007-9795-1
Lash TL, Fox MP, Silliman RA. Reduced mortality rate associated with annual mammograms after breast cancer therapy. Breast J. 2006;12(1):2-6. https://doi.org/10.1111/j.1075-122X.2006.00177.x PMID:16409580 DOI: https://doi.org/10.1111/j.1075-122X.2006.00177.x
Yang SH, Yang KH, Li YP, et al. Breast conservation therapy for stage I or stage II breast cancer: a meta-analysis of randomized controlled trials. Ann Oncol. 2008;19(6):1039-1044. https://doi.org/10.1093/annonc/mdm573 PMID:18187486 DOI: https://doi.org/10.1093/annonc/mdm573
Abner AL, Recht A, Eberlein T, et al. Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol. 1993;11(1):44-48. https://doi.org/10.1200/JCO.1993.11.1.44 PMID:8418240 DOI: https://doi.org/10.1200/JCO.1993.11.1.44
Montgomery DA, Krupa K, Jack WJ, et al. Changing pattern of the detection of locoregional relapse in breast cancer: the Edinburgh experience. Br J Cancer. 2007;96(12):1802-1807. https://doi.org/10.1038/sj.bjc.6603815 PMID:17533401 DOI: https://doi.org/10.1038/sj.bjc.6603815
Houssami N, Abraham LA, Miglioretti DL, et al. Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA. 2011;305(8):790-799. https://doi.org/10.1001/jama.2011.188 PMID:21343578 DOI: https://doi.org/10.1001/jama.2011.188
Mellink WA, Holland R, Hendriks JH, Peeters PH, Rutgers EJ, van Daal WA. The contribution of routine follow-up mammography to an early detection of asynchronous contralateral breast cancer. Cancer. 1991;67(7):1844-1848. https://doi.org/10.1002/1097-0142(19910401)67:7<1844::AID-CNCR2820670705>3.0.CO;2-W PMID:1848469 DOI: https://doi.org/10.1002/1097-0142(19910401)67:7<1844::AID-CNCR2820670705>3.0.CO;2-W
Gutter Z. Cancer of the remaining breast: radiologic contribution to diagnosis. Can Med Assoc J. 1976;114(1):27-30. PMID:943222
Senofsky GM, Wanebo HJ, Wilhelm MC, et al. Has monitoring of the contralateral breast improved the prognosis in patients treated for primary breast cancer? Cancer. 1986;57(3):597-602. https://doi.org/10.1002/1097-0142(19860201)57:3<597::AID-CNCR2820570334>3.0.CO;2-5 PMID:3942996 DOI: https://doi.org/10.1002/1097-0142(19860201)57:3<597::AID-CNCR2820570334>3.0.CO;2-5
Robertson C, Arcot Ragupathy SK, Boachie C, Dixon JM et al. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews registry database analyses and economic evaluation. Health Technol Assess. 2011 Sep;15(34):v-vi, 1-322. https://doi.org/10.3310/hta15340 PMID: 21951942 DOI: https://doi.org/10.3310/hta15340
Orel SG, Fowble BL, Solin LJ, Schultz DJ, Conant EF, Troupin RH. Breast cancer recurrence after lumpectomy and radiation therapy for early-stage disease: prognostic significance of detection method. Radiology. 1993;188(1):189-194. https://doi.org/10.1148/radiology.188.1.8511295 PMID:8511295 DOI: https://doi.org/10.1148/radiology.188.1.8511295
Ghezzi P; The GIVIO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. JAMA. 1994;271(20):1587-1592. https://doi.org/10.1001/jama.1994.03510440047031 PMID:8182811 DOI: https://doi.org/10.1001/jama.271.20.1587
Rosselli Del Turco M, Palli D, Cariddi A, Ciatto S, Pacini P, Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up. JAMA. 1994 May 25;271(20):1593-7. https://doi.org/10.1001/jama.1994.03510440053032 PMID:7848404 DOI: https://doi.org/10.1001/jama.271.20.1593
Natoli C, Brocco D, Sperduti I. et al.“FOLLOW-UP” Study Group. Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey. PLoS One. 2014 Apr 8;9(4):e94063. https://doi.org/10.1371/journal.pone.0094063 PMID: 24714591 DOI: https://doi.org/10.1371/journal.pone.0094063
Swain SM, Miles D, Kim S-B, et al; CLEOPATRA study group. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA): end-of-study results from a double-blind, randomised, placebo-controlled, phase 3 study. Lancet Oncol. 2020;21(4):519-530. https://doi.org/10.1016/S1470-2045(19)30863-0 PMID:32171426 DOI: https://doi.org/10.1016/S1470-2045(19)30863-0
Hortobagyi GN, Stemmer SM, Burris HA, et al. Overall Survival with Ribociclib plus Letrozole in Advanced Breast Cancer. N Engl J Med. 2022;386(10):942-950. https://doi.org/10.1056/NEJMoa2114663 PMID:35263519 DOI: https://doi.org/10.1056/NEJMoa2114663
Schmid P, Adams S, Rugo HS, et al; IMpassion130 Trial Investigators. Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med. 2018;379(22):2108-2121. https://doi.org/10.1056/NEJMoa1809615 PMID:30345906 DOI: https://doi.org/10.1056/NEJMoa1809615
Emens LA, Adams S, Barrios CH, et al. First-line atezolizumab plus nab-paclitaxel for unresectable, locally advanced, or metastatic triple-negative breast cancer: IMpassion130 final overall survival analysis. Ann Oncol. 2021;32(8):983-993. https://doi.org/10.1016/j.annonc.2021.05.355 PMID:34272041 DOI: https://doi.org/10.1016/j.annonc.2021.05.355
Fresco R, Spera G, Meyer C, Cabral P, Mackey JR. Imaging radiation doses and associated risk and benefits in subjects participating in breast cancer clinical trials. Oncologist. 2015;20(7):702-712. https://doi.org/10.1634/theoncologist.2014-0295 PMID:26025934 DOI: https://doi.org/10.1634/theoncologist.2014-0295
Braun S, Vogl FD, Naume B, et al. A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 2005;353(8):793-802. https://doi.org/10.1056/NEJMoa050434 PMID:16120859 DOI: https://doi.org/10.1056/NEJMoa050434
Sparano J, O’Neill A, Alpaugh K, et al. Association of circulating tumor cells with late recurrence of estrogen receptor-positive breast cancer: a secondary analysis of a randomized clinical trial. JAMA Oncol. 2018;4(12):1700-1706. https://doi.org/10.1001/jamaoncol.2018.2574 PMID:30054636 DOI: https://doi.org/10.1001/jamaoncol.2018.2574
Sant M, Bernat-Peguera A, Felip E, Margelí M. Role of ctDNA in breast cancer. Cancers (Basel). 2022;14(2):310. https://doi.org/10.3390/cancers14020310 PMID:35053474 DOI: https://doi.org/10.3390/cancers14020310
Garcia-Murillas I, Schiavon G, Weigelt B, et al. Mutation tracking in circulating tumor DNA predicts relapse in early breast cancer. Sci Transl Med. 2015;7(302):302ra133. https://doi.org/10.1126/scitranslmed.aab0021 PMID:26311728 DOI: https://doi.org/10.1126/scitranslmed.aab0021
Turner NC, Swift C, Jenkins B, et al; c-TRAK TN investigators. Results of the c-TRAK TN trial: a clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate- and high-risk early-stage triple-negative breast cancer. Ann Oncol. 2023;34(2):200-211. https://doi.org/10.1016/j.annonc.2022.11.005 PMID:36423745 DOI: https://doi.org/10.1016/j.annonc.2022.11.005
Percorso DTA. (PDTA) per i pazienti affetti da tumore della mammella - Elaborato dalla Rete Oncologica Veneto (ROV) 2022. https://salute.regione.veneto.it/c/document_library/get_file?uuid=e6eccee3-843d-4ed0-8378-f810d80d3360&groupId=534936. (Accessed June 22, 2023)
Hojo T, Masuda N, Mizutani T, et al. Intensive vs. standard post-operative surveillance in high-risk breast cancer patients (INSPIRE): Japan Clinical Oncology Group Study JCOG1204. Jpn J Clin Oncol. 2015;45(10):983-986. https://doi.org/10.1093/jjco/hyv110 PMID:26246481 DOI: https://doi.org/10.1093/jjco/hyv110
Zamagni C, Gion M, Mariani L, et al. CA15.3 and 18-FDG PET in the follow-up of early breast cancer (BC) patients (pts): A prospective, multicentric, randomized trial—KRONOS patient-oriented new surveillance study Italy. J Clin Oncol. 2017;35(15_suppl):TPS11627. https://doi.org/10.1200/JCO.2017.35.15_suppl.TPS11627 DOI: https://doi.org/10.1200/JCO.2017.35.15_suppl.TPS11627
Gustafson DH, Shukla RK, Delbecq A, Walster GW. A comparative study of differences in subjective likelihood estimates made by individuals, interacting groups, Delphi groups, and nominal groups. Organ Behav Hum Perform. 1973;9(2):280-291. https://doi.org/10.1016/0030-5073(73)90052-4 DOI: https://doi.org/10.1016/0030-5073(73)90052-4
Rowe G, Wright G. Expert opinion in forecasting: role of the Delphi technique. In: Armostrong JS (Ed.), Principles of forecasting. Kluwer Academic Press. 2001; pag 125-126. https://doi.org/10.1007/978-0-306-47630-3_7 DOI: https://doi.org/10.1007/978-0-306-47630-3_7
Published
How to Cite
License
Copyright (c) 2024 Stefania Gori, Alberto Zambelli, Catia Angiolini, Antonella Ferro, Fiorenza De Rose, Alessandra Fabi, Giuseppe Azzarello, Giuseppe Bogina, Maurizio Cancian, Matteo Valerio, Michela Cinquini, Fabrizio Nicolis, Giovanni Pappagallo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors contributing to AboutOpen agree to publish their articles under the Creative Commons NonCommercial 4.0 International License (CC BY-NC 4.0), which allows third parties to copy and redistribute the material providing appropriate credit and a link to the license but does not allow to use the material for commercial purposes and to use the material if it has been remixed, transformed or built upon.
Accepted 2024-01-16
Published 2024-02-23
