Follow-up after grade 1 breast cancer may not be needed


NEW YORK (Reuters Health), Aug 25 - Women treated for grade 1 breast cancer have a low risk of locoregional recurrence and contralateral breast cancer, results of a study indicate.

"Consequently, (they) can be discharged from hospital follow-up to join a mammographic surveillance program without compromise to their quality of care," Dr. Michalis Kontos from Guy's Hospital, London, noted in an e-mail to Reuters Health.

"This would reduce the follow-up clinic's workload by about 15% -- a considerable amount in these money-conscious times," Kontos added.

Kontos and colleagues evaluated rates of locoregional recurrence and contralateral breast cancer after primary treatment (surgery plus radiotherapy and/or chemotherapy) in 1,143 consecutive women with operable breast cancer.

According to a report in the British Journal of Surgery for August, 650 of the women had breast-conserving treatment and 493 had modified radical mastectomy.

At a mean follow-up of 9.1 years, the 10-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer for grade 1, 2, and 3 breast cancer were 0.03, 0.12, and 0.16, respectively.

"Ten-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer were four and more than five times higher for grades 2 and 3 in comparison to grade 1 tumors," Kontos told Reuters Health.

For grade 1 tumors, the risk of locoregional recurrence or contralateral breast cancer was 285 per 100,000 person-years, "which is not significantly different to the risk of the general (U.K.) population to develop a primary breast cancer," Kontos noted.

"The rising incidence of breast cancer and the advances in its treatment have led to a significant increase in the number of survivors after treatment for breast cancer," the study team notes. "With finite resources, clinics could be targeting patients with a higher risk of relapse, and breast cancer follow-up could be individualized."

While most clinicians still favor follow-up, there is no agreement on its length or intensity. The current study, Kontos and colleagues write, suggests that "women who have completed treatment for grade 1 breast cancer could be discharged from hospital follow-up, receive their adjuvant hormonal therapy from their general practitioner, and join a national screening or mammographic surveillance program."

At Guy's Hospital, this would have reduced the follow-up load by 14.5%, they note.

By Megan Brooks

Br J Surg 2009;96:999-1004.

Last Updated: 2009-08-24 10:31:05 -0400 (Reuters Health)

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