Breast Carcinoma Surveillance Counterpoint: USA

Abstract

Historically, the incidence of breast cancer has been increasing. However, the incidence of breast cancer in the USA decreased by 2.2 % per year from 1999 to 2005 [1]. The increasing population in the USA means the absolute number of women diagnosed with breast cancer continues to increase yearly, with an estimated 192,370 new cases in 2009 [1]. This, in combination with decreasing mortality rates, has now led to an increase in the number of breast cancer survivors who need long-term follow-up [2]. There has been significant debate over what tests should be obtained, how often they should be obtained, how long surveillance should be continued, and by whom this should be performed. The National Comprehensive Cancer Network guidelines recommend interval history and physical examination every 4–6 months for 5 years and then annually thereafter, with mammogram every 12 months (the first posttreatment mammogram to be obtained 6–12 months following the completion of chemotherapy). For women on tamoxifen or aromatase inhibitors, annual gynecologic examinations are recommended. Regular bone mineral density examinations are recommended for women on aromatase inhibitors. No other routine laboratory and/or imaging modalities are currently recommended for routine surveillance. Further testing is only recommended when abnormalities are detected by history, physical examination, or mammography, as routine testing has not been shown to improve overall or disease-free survival [3, 4]. Surveillance recommendations are not stratified based on stage of cancer at time of initial diagnosis or treatment. The American Society of Clinical Oncology guidelines are similar: history and physical examination every 3–6 months for the first 3 years, every 6–12 months for years 4 and 5, and then annually thereafter, with further testing only if symptoms arise. Annual mammography, gynecologic examination, and bone mineral density examination recommendations mirror the National Comprehensive Cancer Network guidelines [5].