NICE guidelines on breast cancer follow-up need urgent revision

Survival continues to improve, so new cancers are now more common in many patients than recurrence because the treatments of the first cancer are so effective. However, follow-up protocols still vary widely both within and between countries and are not always evidence based.

The National Institute for Health and Clinical Excellence (NICE) in England and Wales state that the aims of breast cancer follow-up are to detect and treat local recurrence, to deal with adverse effects of treatment and to provide psychological support.

The guidelines suggest that these aims can be met by two to three years of follow-up, and that routine long term follow-up is ineffective and unwarranted. They also claim that the yield from mammography is low.

But Michael Dixon, Consultant Surgeon at Edinburgh Breast Unit and David Montgomery, Clinical Research Fellow at Glasgow Royal Infirmary, argue that the NICE guidelines do not meet their stated aims.

Although true local recurrence after breast conserving surgery falls with time, the development of new cancers in the treated breast increases, so the overall rate of ipsilateral breast events is constant at 0.5 to 1% each year for at least the first 10 years and probably for the rest of the patient’s life.

If “recurrences” in the treated breast and armpit are combined together with new cancers in the opposite breast, the annual incidence of treatable disease is constant at 1 to 1.5% for at least the first 10 years, and 70% of such events occur after the first three years.

If NICE is to achieve its aim of detecting and treating local recurrence it clearly cannot be achieved with a three year follow-up, they say.

Data also show that mammography is a very effective way to detect treatable local disease, and fully funded mammographic surveillance programmes specifically for patients with breast cancer are urgently needed, they add.

In contrast to NICE guidelines, they recommend that clinical examination should be annual for two years and surveillance by mammography thereafter.

Ongoing psychological support should also be available, and in between visits for mammograms, patients should have direct access to a named breast care nurse, specialist nurse or doctor and access to prosthesis advice and fitting.

Timely investigation of symptoms and communication of test results is also vital to reduce anxiety and improve ongoing care.

Patients’ needs vary, so follow up programmes for patients with breast cancer patients need to be evidence based, flexible, and tailored to their lifelong needs, they conclude.

Source: British Medical Journal

Biologic treatment for rheumatoid arthritis and the risk of cancer
The relationship between rheumatoid arthritis (RA), an autoimmune disease marked by chronic inflammation of the joints and tissue surrounding vital organs, and the incidence of cancer is complicated. Epidemiologic studies have generally demonstrated that blood, lung, and skin cancers are increased among RA patients, while breast and colon cancers are decreased.
Dendritic cells stimulate cancer-cell growth
Since their discovery at Rockefeller University some 30 years ago, dendritic cells have been recognized as key players on the immune-system team, presenting antigens to other immune cells to help them respond to novel insults. Now, Rockefeller scientists have shown that dendritic cells also have other, non-immune actions, and may in fact directly modify the biology of some types of cancer cells.
Creating lung cancer risk models for specific populations refines prediction
Lung cancer risk prediction models are enhanced by taking into account risk factors by race and by measuring DNA repair capacity, according to research teams led by epidemiologists at The University of Texas M. D. Anderson Cancer Center in two complementary papers appearing in the September issue of Cancer Prevention Research.
1 step back ... 2 steps forward
Women with hormone-receptor positive, metastatic breast cancer may take medications for years to help keep their cancer at bay, but when the tumor becomes resistant to anti-hormonal drugs, treatment with chemotherapy becomes the only option. But a study presented today at the 2008 ASCO Breast Cancer Symposium may change this approach. Early data suggests a new treatment approach can "re-sensitize" the tumor, allowing anti-hormonal drugs to do their job once again.
Postmenopausal women taking anastrozole as a chemopreventive treatment do not have impaired cognitive performance
New results of a sub-study carried out as part of a worldwide breast cancer prevention study (IBIS-II) show that after two years of taking the aromatase inhibitor, anastrozole, postmenopausal women at high risk of breast cancer do not have impaired cognitive performance.
Studies spot numerous undiscovered gene alterations in pancreatic and brain cancers
HHMI investigators have detected a multitude of broken, missing, and overactive genes in pancreatic and brain tumors, in the most detailed genetic survey yet of any human tumor. Some of these genetic changes were previously unknown and could provide new leads for improved diagnosis and therapy for these devastating cancers.
Bisphenol A linked to metabolic syndrome in human tissue
New research from the University of Cincinnati (UC) implicates the primary chemical used to produce hard plastics—bisphenol A (BPA)—as a risk factor for metabolic syndrome and its consequences.
Potential remedy for the 'mental fog' in cancer patients
Cancer patients have complained for years about the mental fog known as chemobrain. Now in animal studies at West Virginia University (WVU), researchers have discovered that injections of N-acetyl cysteine (NAC), an antioxidant, can prevent the memory loss that breast cancer chemotherapy drugs sometimes induce. The WVU researchers' study has just been published in the September issue of the Springer journal Metabolic Brain Disease.

NICE guidelines on breast cancer follow-up need urgent revision

Related stories:

News discussion: