ROUTINE FOLLOW UP OF BREAST CANCER PATIENTS
WHEN AND HOW TO ORIENTATE
Keywords:
neoplasms, follow up studiesAbstract
The necessity and the method of follow-up of breast cancer patients is a controversial issue. There are divergences among professionals about which exams should be asked and periodicity of consultations. Some routine procedures adopted nowadays do not have support of scientific evidence. From the point of view of regional control, to orientate the patient to do breast self-exam and consultations each 4 to 6 months with annual mammography is a consensual and efficient procedure. The less defined aspect refers to routine research of hematogenous metastases inpatients with no symptoms. This subject has been discussed with antagonistic opinions. The request of several routine laboratorial and radiological exams produces a high cost, stresses out the patients, and there is no evidence of survival improvement. At least two prospective European studies comparing survival of patients with no symptoms Who underwent routine exams versus follow-up oriented by complaints showed equal survival. For patients Who do not participate in prospective studies, which represent the majority of the cases, follow-up with clinical examination and request of exams when symptoms demand is a good alternative when considering cost/benefit.
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ABERIZK, W.J. et ai. The use of radiotherapy for treatment of isolated locoregional recurrence of breast carcinoma after mastectomy. Câncer, New York, v.58,p.1212-1218, 1986.
ABNER, A.L. et al. Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol, Baltimore, v. 11, n. 1, p.44-48, 1993.
ABRAMS, J.s., PHILLIPS, P.H., FRIEDMAN, M.A. Meeting highlights: a reappraisal of research results for the local treatment of early-stage breast cancer. J Nat Cancer Inst, Bethesda, v.87, n.24,p.1837-1845, 1995.
ASCO Special Article. Recommended breast cancer surveillance guidelines.J Clin Oncol, Baltimore, v.15, p.2149-2156, 1997.
BAKEMEIER, R.F. Principles of medical oncology and cancer chemotherapy. ln: RUBIN, P. Clinical oncology for medical students and physicians. RochesterNY : ACS, 1978. p.43.
BRASIL. Ministério da Saúde. O problema do câncer no Brasil. 4.ed. Rio de Janeiro: INCa, 1997.
CIATTO, S. Aula sobre seguimento das pacientes com câncer da mama (European School of Oncology). Curso de atualização. Florianopolis, junho, 1996.
CIATTO, S.et al. Chest X ray survey in the follow up of breast cancer patients. Br J Cancer, London, v.60, p.102-5, 1989.
COLOMER, R. et al. Circulating CA 15-3 serum levels in the post-surgical follow up of breast cancer patients and in non-malignant diseases. Breast CancerRes Treat, Hague, v. 13, n.2, p. 123-133, 1989.
DUARTE, D.L. Rastreamento de câncer no Brasil. Radiol Bras, São Paulo, v.29, p.5-6, 1996. (Editorial).
ESKELINEN, M. et al. Serum tumor markers CEA, AFP, CA 15-3, TPS in diagnosis of breast cancer. Anticancer Res, New York, v. 17-2B, p. 1231-1234, 1997.
ESTEBAN, J.M. al. Prognostic relevance of CEA and estrogen receptor status in breast cancer patients. Cancer, New York, v.74, p. 1575-1583, 1994.
GADELHA,M.I.P. Validade dos marcadores tumorais. Rev Bras Cancerol, Rio de Janeiro, v.44, n.3, p.211-224, 1998.
GALINDO, E.G., BUZDAR, A.U. Avaliação de pacientes em seguimento ap6s tratamento. ln: FARIA, s.L., LEME, L.H.S., OLIVEIRA FILHO, J.A. Câncer da mama, diagnóstico de tratamento. Rio de Janeiro: Medsi, 1994. pl 97.
GIAI, M. et al. TPS and CA 15-3 serum values as a guide for treating and monitoring breast cancer patients. Anticancer Res, New York, v. 1 6, n.2, p.875-881, 1996.
GIVIO Investigators: impact of follow-up testing on survival and health-related quality of life in breast cancer patients: a multicenter randomized controlled trial. JAMA, Chicago, v.271, p.1587-1592, 1994.
GRUNFELD, E., MANT, D. etal. Routine follow up of breast cancer in primary care: a randomised trial. Br Med J, London, v.313, p. 665-669, 1996.
GULLIFORD, J. et al. Popularity of less frequent follow up for breast cancer in randomised study. BrMedJ, London, v.314, p. 174-177, 1997.
HAFFTY, B.G. et al. Prognosis following local recurrence in the conservatively treated breast cancer patient. Int J Rad Oncol Biol Phys, New York, v.21, n.2, p.293-298, 1991.
HALVERSON, K.J. et al. Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management. Int J Rad Oncol Biol Phys, New York, v. 19, n.4, p.851-858, 1990.
HANNISDAL, E., GUNDERSEN, S., KVALOY, S. et al. Follow up of breast cancer patients’ stage I - Il: a baseline strategy. EurJ Cancer, London, v.29A,p.992-997, 1993.
HARRIS, J.R., MORROW, M., NORTON, L. Malignant tumors of the breast. In: DEVITTA, v.T., HELLMANN, S., ROSEMBERG, S.A. Cancer, principles and practice of oncology. 5.ed. Philadelphia: Lippincott-Raven, 1997. p.1557.
HOLLI, K., HAKAMA, M. Effectiveness of routine and spontaneous follow up visits for breast cancer. EurJ Cancer Clin Oncol, London, v.25, p.251-254, 1989.
KENNEDY,M.,ABELOFF,M., Managementof locally recurrent breast cancer. Cancer, New York, v. 71, p.2395-2401, 1993.
LEE, Y.T.N. Biochemical and hematological tests in patients with breast carcinoma. Correlations with extent of disease, sites of release prognosis. J surg Oncol, New York, v.29, p.242-248, 1985.
LICHTER, A.S. et al. Mastectomy versus breast-conserving therapy in the treatment of stage I and Il carcinoma of the breast: a randomized trial at the National Cancer Institute. J Clini Oncol, Baltimore, v. 10, p.976-983, 1992.
LOPRINZI C. It is now the age to define the appropriate follow up of primary breast cancer patients. J Clin Oncol, Baltimore, v. 12, p.881-887, 1994.
NATIONAL COMPREHENSIVE CANCER NETWORK Guidelines for Treatment of Breast Cancer. NCCN Oncology Practice. Oncol, New York, v.11, p. 199-222, 1997.
O'HANLON, D.M. et al. A prospective evaluation of CA 15-3 in stage I carcinoma of the breast. J Am Coil Surgicol, New York, p.210-212, 1995.
OJEDA, M.B. et al. Follow up of breast cancer stages I and Il. An analysis of some common methods. Eur J Cancer Clin Oncol, London, v.23,p.419-423, 1987.
PANDYA, K.J. et al. A retrospective study of earliest indicators of recurrence in patients on Eastern Cooperative Oncology Group Advuant Chemotherapy Trials for Breast Cancer. Cancer, New York, v55, p.202-205, 1985.
PEDRAZZINI, A. et al. First repeated bone scan in the observation of patients with operable brest cancer.JClin Oncol, New York, v.4, p.389-394, 1986.
ROSSELLI DEL TURCO, M. et al. Intensive diagnostic follow up after treatment of primary breast cancer. A randomized trial. JAMA, Chicago, v.276, p. 1593-1600, 1994.
SCHAPIRA,D.V., URBAN,N.Aminimalistp01icy for breast cancer surveyllance. JAMA, Chicago, v.265, p.380-382, 1991.
SCHWAIBOLD, F. et al. The results of radiation therapy for isolated local regional recurrence after mastectomy. Int J Rad Oncol Biol Phys, New York, v.21, p.299-310, 1991.
TAMPELLINI, M. al. Relationship between CA 15-3 levels and disease extent in predicting overall survival of breast cancer patients with newly diagnosed metastatic disease. Br J Cancer, London, v. 75, n.5, p.698-702, 1997.
VERONESI, U. et al. Breast conservation is a safe method in patients with small cancer of the breast: long-term results of three randomised trials on 1,973 patients. Eur J Cancer, London, v.3 IA, n.10,p.1574-1579, 1995.
WERTHEIMER, M.D. Against minimalism in breast cancer follow-up. JAMA, Chicago, v.265, p.396-397, 1991.
