This is another repeat topic, but it is one that comes up over and over and always seems counterintuitive. The brief summary is that medical oncologists, for routine follow-up visits for women with Stage I, II, or III breast cancer, generally rely on physical exams and a careful history/discussion rather than on any blood tests or scans. This has evolved over time. When I first began this work, more than 30 years ago, women were routinely followed with bone scans, chest X-rays, and blood tests after completing adjuvant treatment. When I had my first breast cancer in 1993, annual chest X-rays were the remaining part of that plan. A few years later, those X-rays were stopped, too.
Since there is so much discussion about the importance of early detection for primary breast cancer (although there is also a lot of discussion about the value of mammograms and whether they save lives), women naturally assume that a similar effort will be made to detect early metastatic breast cancer. Wrong. All of the studies indicate that women do just as well and live just as long if a metastasis is found because there is a symptom rather than on a scan or blood test. That means that a woman will do just as well if she goes to her doctor in January because her back has been hurting (and bone mets are found) as she would have done had those same bone mets been seen in a bone scan in the previous October. All of the major oncology organizations (e.g. ASCO) recommend NOT doing routine scans and blood tests/markers unless there is a suspicion of a problem.
This is a very good interview from LBBC with Dr. Nancy Lin about these issues. Here is the beginning and then a link to read more:
July 2012 Ask the Expert: Follow-Up Testing
Nancy U. Lin, MD
Dr. Lin is assistant professor in the department of medicine at Harvard Medical School. She is a medical oncologist at Dana-Farber Cancer Institute focusing on the care of women with breast cancer.
Question: What is the standard for three-month checkups with the oncologist? What tests are run? What do they look at in the blood work that can indicate recurrence?
Dr. Lin: I am assuming you had a diagnosis of stage I, II or III breast cancer and completed chemotherapy and radiation, if either were necessary. You may still be taking hormonal therapy with tamoxifen, anastrozole (Arimidex), exemestane (Aromasin) or letrozole (Femara). If so, your oncologist is now transitioning you to the survivorship phase of your breast cancer care.
Typically, oncologists see patients every three to six months, depending on patient needs, symptoms, etc. I typically see patients two to three times the first year and then twice a year thereafter if things are going well. Although it may seem counterintuitive, other than yearly mammograms and physical examination at each visit, I do not do routine scans or blood tests to look for cancer recurrence.
Two large studies compared women followed with usual care (that is, doctor's visits, physical examination, review of symptoms, mammograms) to women followed with "extra" testing (that is, blood tests, liver scans, bone scans, chest X-rays). These studies found no difference in a woman's chances of survival or length of survival after breast cancer with the "extra" testing. Even with patients in the "extra" testing group, most recurrences were found between tests, when a woman brought a symptom to the doctor's attention or a doctor noted something during a clinic visit.
So, all the professional oncology organizations actually recommend AGAINST routine blood work or scans as part of follow-up, with the exception of mammograms. This can create anxiety. I encourage you discuss your concerns with your doctor.
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