HEALTH & SCIENCE

Some breast cancer survivors require fewer follow-up tests

Once a patient is finished with treatment and feels fine, she can return to regular checkups and annual mammograms.

By Victoria Stagg Elliott, AMNews staff. Feb. 14, 2005.

The patient was panicked when she arrived in the office of internist Janet Pregler, MD, director of the Iris Cantor-UCLA Women's Health Center in Los Angeles. Her breast cancer had been successfully treated, but the last blood test done by her surgeon showed a slightly elevated tumor marker. She was convinced that the cancer had returned. She thought she would be dead in a year.

That was six years ago. The patient is still alive. The tumor marker is still slightly elevated. And the cancer still hasn't returned.

Stories like this illustrate how in some cases intensive follow-up of breast cancer survivors whose disease was detected early does little good while causing significant anxiety, increased costs and a lower quality of life. The evidence is leading many physicians to alter their approaches.

"There are definite things that we need to be doing for breast cancer survivors that are useful and helpful. Our focus really needs to be there because doing all these chest x-rays and liver tests and tumor markers is not helpful," said Dr. Pregler. "[This patient] had to see every different kind of specialist and have every different kind of test. The false positives are really distressing."

Most recently, a meta-analysis published in the Cochrane Library in January found that intensive testing did nothing to impact survival rates overall or to reduce time to detection of a recurrence.

"Less intensive follow-up strategies based on periodic clinical exam and annual mammography seem as effective as more intense surveillance schemes," wrote the researchers from the Mario Negri Institute in Milan, Italy.

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