We should not request unnecessary tests during follow-up after breast cancer recovery!

Breast cancer patients’ greatest wish is to recover from the disease. At initial diagnosis, fear of dying from the disease is at its highest. Metastasis has not occurred in early-stage breast cancer, and when the physician explains that treatment will free the patient from the disease, a period of relief begins. After surgery, chemotherapy and radiotherapy when needed, the main treatments are completed and follow-up begins.

Before this process begins, the physician explains that intensive treatment is complete, the patient has recovered and follow-up will now begin. During the approximately 6-month intensive treatment period, the patient has become very attached to the oncology team and has almost lived alongside them. Being close to the healthcare team during this time also makes the breast cancer patient feel safe. However, this period ends, close contact with the team is over, and follow-ups every 3-6 months will begin. The patient will return to their former life and resume their routine where they left off.

At this very point, a new fear takes hold: breast cancer returning, meaning the disease confronting them again, fear of recurrence. A recovered breast cancer patient wants everything possible done during follow-up and, if necessary, many tests performed at each visit to explain whether the disease has recurred or will recur. In this article, we wanted to inform you about unnecessary tests during post-treatment follow-up.

According to a study presented at ASCO 2017, early-stage breast cancer patients in follow-up undergo excessive tumor marker, blood and imaging tests.

Study

The study examined insurance records in Eastern Washington, United States, for early-stage breast cancer patients, totaling 2156, from 2007- 2015. Of the patients, %84 had stage 1 and %16 had stage 2 breast cancer.

All patients entered follow-up after treatment. They were examined for whether they underwent tumor marker blood tests (CEA, CA 15-3, CA 27.29) and advanced imaging (PET, computed tomography and bone scans). It was found that, of every 3 patients, more than 1 (%37) had an unnecessary tumor marker blood test requested. Also, of approximately every 5 patients, 1 (%17) underwent unnecessary advanced radiological imaging.

Which patients should be followed more closely after treatment?

Patients whose initial tumor was larger than 5 cm or who had spread/metastasis to more than 3 axillary lymph nodes, with stage 2B or stage 3 disease, are considered high risk, and the tests listed above may be requested in their follow-up. However, earlier-stage breast cancer patients in follow-up should not undergo unnecessary tests unless they have suspicious complaints such as a new palpable lump or persistent pain.

Unnecessary tumor marker blood tests or advanced imaging have many disadvantages, including stress and wasted time and money. Moreover, performing tumor marker tests in patients with no complaints is not effective for early detection of disease recurrence.

Although efforts are made to minimize recurrence risk with protective - adjuvant treatments, fear of recurrence is the leading concern experienced by patients and family members. Psychological support measures have been observed to substantially reduce patients’ concerns, and patients overcome their fears more easily when they accept that cancer recurrence sometimes cannot be clearly predicted. In addition, physician education appears to be the best first step in preventing unnecessary test requests during early-stage breast cancer follow-up.