New Breast Cancer Survivorship Guidelines

The American Cancer Society and American Society of Clinical Oncology collaborated to create survivorship guidelines to assist primary care and other clinicians in the care of women with breast cancer. The guidelines were published in the January/February 2016 issue of CA: A Cancer Journal for Clinicians, which is available here.

The guidelines team noted that there are many evidenced-based guidelines for the diagnosis and treatment of female breast cancer; however, there were few to none that addressed the various components of breast cancer survivorship. A search was conducted to assess the published literature on five key areas of breast cancer survivorship:

• Surveillance for recurrence
• Screening for second primary cancers
• Management of long-term and late effects of disease and treatment
• Health promotion
• Coordination of care

It is recommended that primary care clinicians should individualize clinical follow-up care provided to breast cancer survivors based on age, specific diagnosis, and treatment protocol, and ensure that the patient receives a detailed cancer-related history and physical examination every 3 to 6 months for the first 3 years after primary therapy; every 6-12 months for the next 2 years, and annually thereafter.

Primary care clinicians should refer women who have received a mastectomy for annual mammography of the intact breast and, for those with lumpectomies, an annual mammography of both breasts. They should not refer for routine screening with MRI of the breast unless the patient meets high-risk criteria for increased breast cancer surveillance. Routine laboratory tests should not be performed for the detection of disease recurrence in the absence of symptoms. Primary care clinicians need to educate and counsel all women about the signs and symptoms of local or regional recurrence, assess the patient's cancer family history, and offer genetic counseling if potential hereditary risk factors are suspected.

Women should be counseled to adhere to adjuvant endocrine therapy, educated about the signs and symptoms of local or regional recurrence, and advised on how to manage common symptoms (eg, fatigue, distress, pain). Women also should be assessed for long-term treatment-related effects, such as cognitive impairment and cardiotoxicity.