Clinical Practice Guidelines

I. Staging

For all groups, a complete history and physical should be performed along with a bilateral mammogram and review of pathology. Abnormal results should be further investigated. Specific cut-points for tumor size and number of positive nodes are not absolute but provide points of reference. Physician judgment, based on published, peer-reviewed data is important in the application of guidelines.

  1. High risk of breast cancer
    1. Gail model risk assessment
    2. If tamoxifen is to be given, complete metabolic profile, and serum pregnancy test if <50 years of age.

  2. Very low risk of initial gross metastases (DCIS, invasive tumor < 2 cm and negative nodes)
    1. If systemic therapy is to be given, complete metabolic profile and serum pregnancy test if <50 years of age.

  3. Low risk of initial gross metastases (tumor size 2-5 cm, and negative nodes)
    1. Complete blood count (CBC)
    2. Comprehensive metabolic panel (CMP)
    3. Serum pregnancy test (<50 yrs) if systemic therapy anticipated
    4. + CXR – PA and lateral

  4. Intermediate risk of initial gross metastases (nodal involvement by H&E, 1-3 positive nodes)
    1. 1. CBC
    2. CMP
    3. Serum pregnancy test (<50 yrs)
    4. CXR - PA and lateral
    5. +/- bone scan

  5. High risk of initial gross metastases (tumor size > 5 cm, or > 3 positive notes by H&E)
    1. CBC
    2. CMP
    3. Serum pregnancy test (<50 yrs)
    4. CXR , PA and lateral or CT chest
    5. Bone scan
    6. CT of abdomen

II. Follow-up

TEST

FREQUENCY

History/eliciting of symptoms and PE

Every 6 months x 5 years, then annually if no further systemic therapy. If on AI, every 6-12 months.

Bilateral mammograms

Annually, consider stopping at 75 yrs.

Patient education regarding symptoms of recurrence

Written explanation and description should be provided to the patient.

Routine health maintenance

As recommended by peer-reviewed guidelines

Bone mineral density

Baseline and at one - two years if on AI

 

After the primary treatment of breast cancer, follow-up by multiple specialists is not necessary and may represent duplication of effect. Continuity of care should be encouraged and conducted by a physician experienced in the surveillance of breast cancer patients.

 

Reviewed, updated February 15, 2006
Jenny Chang , M.D.
Richard Elledge , M.D.
Mamta Kalidas , M.D.
Rush Lynch, M.D.
Kent Osborne , M.D.
Suzanne Perez , RN, BSN
Mari Rude , RN, ANP