Breast cancer requires an interdisciplinary management plan, and at various points in treatment, care shifts between surgeon, medical oncologist, and radiation oncologist. In addition, radiologists and pathologists remain critical players in the appropriate diagnosis, work-up, and staging of the disease.
As I write this I am leaving the 2009 Breast Cancer Symposium, held in San Francisco. I was honored to be a member of the Steering Committee as a representative of my group, The National Consortium of Breast Centers (NCBC), and also served as co-chair for the Survivorship session. One of the best talks in our session was given by Dr. Eva Grunfeld of the Cancer Outcomes Research Program, Division of Medical Oncology, Dalhousie University, Halifax, Nova Scotia. She discussed how women breast cancer survivors should be followed as they enter survivorship, specifically defined as the point in which curative-intent treatment completes.
Breast cancer requires an interdisciplinary management plan, and at various points in treatment, care shifts between surgeon, medical oncologist, and radiation oncologist. In addition, radiologists and pathologists remain critical players in the appropriate diagnosis, work-up, and staging of the disease. Women often perceive the treatment as a battle to be fought and won, and we (all of us who provide cancer care) are there to give her the tools, encouragement, and support to fight this battle. Yet, once we've done all we can and women enter remission, these tools are withdrawn, the battle armor must be put away. But even the words of encouragement that we give ("Congratulations! You made it!" or "Now, go and live") can sound terrifying. Women are indeed, changed following treatment for breast cancer.
So how should they be followed? Dr. Grunfeld (Ref 1) presented phenomenal data suggesting that routine care by the physician the patient chooses to do this follow-up achieves the same outcomes as follow-up by the cancer specialist. She stressed, however, that this one physician must be chosen in concert with the patient, not dictated. It is even more important that all providers agree on the same strategy of follow-up. According to the American Society of Clinical Oncology, this consists of routine visits, general exams, mammograms annually, and not much else-- no blood tests or x-rays or CT scans. Why? Because intensive follow-up does not improve outcomes. Plain and simple. It was a heart-felt presentation and one filled with the data to back up recommendations that women do not require multispecialty follow-up of their breast cancer; that we can actually feel comfortable that one provider follow cancer survivors, and that one provider can definitely be the primary care physician.
On a separate note, my colleague, Blake Cady, from NCBC also presented a paper on mammograms and death from breast cancer. The study followed almost 7000 women from Massachusetts throughout the 1990s and found that regular mammograms were obtained by 80% of the sample. The death rate from breast cancer was 75% among women not screened regularly, compared to 25% in those actively being screened. He extrapolated this data to all women expected to be diagnosed with breast cancer in 2009 and suggested that only 5% screened regularly would be expected to die over the next 13 years; for those that were not undergoing screening, this figure was estimated to be as high as 15%. This sobering study again emphasizes the positive impact of screening mammography on breast cancer rates. We as a community of breast specialists must and will continue to emphasize this for years to come. Read more about this study on Reuters: http://www.reuters.com/article/rbssBiotechnology/idUSN0644662320091006.
1. Eva Grunfeld. Cancer survivorship: a challenge for primary care physicians. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1562350