Breast Cancer Management and Surveillance
October is Breast Cancer Awareness Month. We reviewed breast cancer diagnosis last week. This week, we are reviewing follow-up after successful treatment of breast cancer.
Guidelines from the American Society of Clinical Oncology suggest that patients with early stage breast cancer may follow up exclusively with a primary care provider (PCP) after initial treatment has been completed. For patients and clinicians who agree with this plan, care may be transferred approximately one year after diagnosis and completion of therapy. In such cases, both the patient and the PCP should be advised of the appropriate follow-up and management strategy by the breast cancer specialist.
For patients receiving hormonal therapy, decisions regarding long-term options may require periodic referral for oncology assessment since treatment strategies are evolving over time. Furthermore, input from an oncology specialist is warranted if there is suspicion or evidence of disease recurrence, or if questions arise regarding the safety of certain interventions or treatments for other conditions.
Some breast cancers have a genetic predisposition. Mutations in either of the breast cancer type 1 or 2 susceptibility genes are referred to as BRCA1 and BRCA2. They account for about 15 percent of women with familial breast cancer and a similar proportion of all women with incidental ovarian cancers. Depending on your family history, testing is widely available now.
In the United States, the five-year survival rate for female breast cancer is approximately 90 percent. Although the majority of breast cancer survivors are women, approximately 2,500 men are diagnosed with breast cancer annually in the United States, and most will achieve long-term disease-free survival. There isn’t enough data to inform the best course of follow-up care for male survivors; recommendations for women are usually applied to men, with modification as appropriate.
In addition to their advised breast cancer care, survivors should receive regular age-appropriate screenings and preventive care to support their overall health.