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Follow-up after grade 1 breast cancer may not be needed

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Women treated for grade 1 breast cancer have a low risk of locoregional recurrence and contralateral breast cancer, results of a study indicate.

As a result, concludes the study team, these women could be discharged from follow-up after completion of primary treatment (surgery plus radiotherapy and/or chemotherapy, “without compromising their quality of care.” Such a policy could also cut costs of breast cancer care.

Dr. Michalis Kontos from Guy’s Hospital, London, and colleagues evaluated rates of locoregional recurrence and contralateral breast cancer after primary treatment in 1143 consecutive women with operable breast cancer. According to a report in the British Journal of Surgery for August, 650 of the women had breast-conserving treatment and 493 had modified radical mastectomy.

At a mean follow up of 9.1 years, the 10-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer for grade 1, 2 and 3 breast cancer were 0.03, 0.12 and 0.16, respectively.

For grade 1 tumors, the risk of locoregional recurrence or contralateral breast cancer was 285 per 100,000 person-years, which is similar to the risk of primary breast cancer in the general screened population in the UK, the researchers note.

“The rising incidence of breast cancer and the advances in its treatment have led to a significant increase in the number of survivors after treatment for breast cancer,” the study team notes. “With finite resources, clinics could be targeting patients with a higher risk of relapse, and breast cancer follow-up could be individualized.”

While most clinicians still favor follow-up, there is no agreement on its length or intensity. The current study, Dr. Kontos and colleagues write, suggests that “women who have completed treatment for grade 1 breast cancer could be discharged from hospital follow-up, receive their adjuvant hormonal therapy from their general practitioner, and join a national screening or mammographic surveillance program.”

At Guy’s Hospital, this would have reduced the follow-up load by 14.5%, they note.

Br J Surg 2009;96:999-1004.