The American Society of Clinical Oncology (ASCO), in collaboration with the American Cancer Society (ACS), have released updated guidelines regarding follow-up care for breast cancer survivors. The updated guidelines were recently published in the Journal of Clinical Oncology.

There is an estimated 3.1 million breast cancer survivors alive today in the United States. At present, 90% of patients diagnosed with breast cancer in the U.S. will be alive 5 years following their diagnosis.  As such, it is imperative to address issues that are unique to breast cancer survivors to improve their quality of life and enable them to remain an integral part of society.

Treatment for breast cancer varies considerably, and is dependent upon the type of breast cancer, the extent of its spread, patients’ risk factors, and a patient’s age.

Each different type of treatment is associated with an increased risk of specific long-term issues.  Therefore, guidelines specifying follow-up for breast cancer survivors is highly individualized to each patient.

The guidelines are updated by a panel of experts in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing. The panel performs an extensive literature review to determine the issues to be addressed in survivors, as well as the follow-up recommendations for healthcare providers caring for a breast cancer survivor.

The most current recommendations set forth the following highlights:

• The frequency of history and physical examinations following completion of therapy should be based upon individual factors.
• Healthcare providers should encourage long-term adherence to endocrine therapy among patients receiving this type of therapy.
• Following completion of treatment, annual mammography should be performed on the intact breast, and the breast affected by cancer if a lumpectomy, not a mastectomy, was performed, to screen for a recurrence.
• MRIs are not recommended for screening for a recurrence, except for those with a high risk for a recurrence in which it is warranted.
• Labs to aid in determining the presence of a cancer recurrence are not recommended.
• Genetic counseling should be offered to patients with a strong family history of certain cancers and/or patients who are 60 years or younger with triple negative breast cancer.
• Screening for cancers other than breast cancer should be performed in accordance to screening recommendations for the general population.
• Psychosocial factors should be addressed, including the following: depression, anxiety, distress, body image issues, sexual concerns, relationship changes, social role difficulties, employment concerns, and financial challenges.
• A gynecologic examination should be performed annually among postmenopausal women on selective estrogen receptor modulator therapies (SERMs).
• A bone density scan (DEXA) should be performed every 2 years among women being treated with certain hormone therapies or those with prematurely induced menopause.
• Prevention of lymphedema, or referral to a lymphedema specialist should be discussed if extensive surgery or lymph node removal is performed and/or radiation has been part of treatment.
• Fertility issues should be discussed among premenopausal women who wish to preserve their fertility.
• Patients should be counseled on signs or symptoms of a recurrence.
• The following physical functioning variables, largely dependent upon treatment types, should be assessed: neuropathy, pain, fatigue, cognitive decline or change, cardiovascular disease, hot flashes, and early menopause.
• Health style choices, including physical activity, nutrition, and smoking cessation should be stressed to reduce the risk or severity of many chronic side effects.
• A survivorship care plan, based on the individual patient’s risk factors and treatment for breast cancer, should be completed and implemented for each patient.
• Survivors with any identified long-term side effects should be referred to an appropriate specialist to prevent or reduce the severity of each identified side effect.

More detailed information regarding the updated guidelines can be found in the Journal of Clinical Oncology: http://jco.ascopubs.org/content/early/2015/12/07/JCO.2015.64.3809.full

A patient’s guide to follow-up care for breast cancer survivors, including questions for patients to ask their healthcare providers and explanations of certain follow-up tests that might be performed, can  also be found in the Journal of Clinical Oncology: http://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/follow-care-breast-cancer.

Survivors of breast cancer who are experiencing changes in physical functioning and/or psychosocial issues should speak with their healthcare provider to obtain appropriate referrals or resources to improve their quality of life.

Reference:  Runowicz C, Leach C, Henry N, et al.  American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guidelines. Available at: http://jco.ascopubs.org/content/early/2015/12/07/JCO.2015.64.3809?jco-home. Accessed January 19, 2016.

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