Optimal Post-Treatment Surveillance in Cancer Survivors: Is More Really Better?

[Debbie L.]

This is such a common topic of discussion here, I thought some would be interested in a new review article in the journal "Oncology", written by two Fox Chase oncologists. It includes 3 common cancers (prostate, colorectal, and breast). The link above is to page 3, where they discuss breast cancer follow-up. They do not go into much depth, but for more information, one can investigate the references.

One of their early statements was puzzling to me, especially since they basically refute it themselves later in the article: "Detection of asymptomatic breast cancer recurrence carries a more favorable prognosis and, together with poor overall outcomes in the metastatic setting, could be an argument for more intensive surveillance post-treatment, in order to enable earlier detection." But it turns out, if you look at the reference they post for that sentence, that the study was looking at LOCAL recurrences in a specific population (a small group of young women after lumpectomy) -- not at metastatic recurrence in a broad group of women. While certainly no one wants a local recurrence, we know that it's the spread (metastasis) that is a threat to life. So it seems to me it was misleading of the authors to make that statement, without clarifying it (simply saying "local", or "in breast" recurrence would have done it).

They do go on to cite the studies that have shown no benefit to more-intense follow-up (tumor markers, imaging, etc) in the absence of symptoms. They also discuss how often (quite often!) both patients and oncologists choose to do more intensive follow-up despite lack of evidence for benefit, and they briefly mention the touchy issue of cost/benefit.

They also do not even mention the subject of HER2+ recurrences in the brain, where some believe that waiting for symptoms will leave fewer (and harsher) treatment options. It's true that there is not good evidence (yet) to support this approach, but I think the idea of brain surveillance after adjuvant Herceptin is considered reasonable by many oncologists (and patients).

So this is not really any new information, just a review of the current evidence, and practices, regarding follow-up after breast cancer.

Debbie Laxague

[thinkpositive]

Debbie,

Thanks for posting. I'm also concerned about not having any testing to see if cancer spreads to brain until after symptoms appear. It seems that monitoring for a period of time after treatment might make sense IF it results in better outcomes.

Take Care