Evaluating the Age-Based Recommendations for Long-Term Follow-Up in Breast Cancer

The oncologist

article

Annemieke Witteveen¹  Sabine Siesling²  Linda de Munck³  Catharina G.M. Groothuis-Oudshoorn²  Gabe S. Sonke⁵  Philip M. Poortmans⁶  Liesbeth J. Boersma⁸  Marjolein L. Smidt⁹  Ingrid M.H. Vliegen^1,11  Maarten J. IJzerman² 

[1] Department of Biomedical Signals and Systems / Personalized eHealth Technology, University of Twente;Department of Health Technology and Services Research, Technical Medical Centre, University of Twente;Department of Research;Department of Epidemiology, University of Groningen, University Medical Center Groningen;Department of Medical Oncology, Netherlands Cancer Institute (NKI);Iridium Kankernetwerk, Wilrijk-Antwerp;University of Antwerp, Faculty of Medicine and Health Sciences;Department of Radiation Oncology, Maastricht University Medical Center (Maastro);GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre;Department of Surgery, Maastricht University Medical Centre;Department of Industrial Engineering and Innovation Sciences, Technical University Eindhoven;University of Melbourne, Centre for Cancer Research and Centre for Health Policy

关键词: Breast cancer;    Risk-based follow-up;    Locoregional recurrence;    Second primary;    Thresholds;   

DOI  :  10.1634/theoncologist.2019-0973

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background After 5 years of annual follow-up following breast cancer, Dutch guidelines are age based: annual follow-up for women 75 years. We determined how the risk of recurrence corresponds to these consensus-based recommendations and to the risk of primary breast cancer in the general screening population. Subjects, Materials, and Methods Women with early-stage breast cancer in 2003/2005 were selected from the Netherlands Cancer Registry ( n = 18,568). Cumulative incidence functions were estimated for follow-up years 5–10 for locoregional recurrences (LRRs) and second primary tumors (SPs). Risks were compared with the screening population without history of breast cancer. Alternative cutoffs for age were determined by log-rank tests. Results The cumulative risk for LRR/SP was lower in women  69 revealed better risk differentiation and would provide more risk-based schedules. Still, other factors, including systemic treatments, had an even greater impact on recurrence risks. Conclusion The current consensus-based recommendations use suboptimal age cutoffs. The proposed alternative cutoffs will lead to a more balanced risk-based follow-up and thereby more efficient allocation of resources. However, more factors should be taken into account for truly individualizing follow-up based on risk for recurrence. Implications for Practice The current age-based recommendations for breast cancer follow-up after 5 years are suboptimal and do not reflect the actual risk of recurrent disease. This results in situations in which women with higher risks actually receive less follow-up than those with a lower risk of recurrence. Alternative cutoffs could be a start toward risk-based follow-up and thereby more efficient allocation of resources. However, age, or any single risk factor, is not able to capture the risk differences and therefore is not sufficient for determining follow-up. More risk factors should be taken into account for truly individualizing follow-up based on the risk for recurrence.

【 授权许可】

CC BY|CC BY-NC