Experts call for review of breast cancer follow-up guidelines
FRIDAY 18 JANUARY 2008
Medical experts are calling for an 'urgent revision' of the NHS guidelines used to determine follow-up care for breast cancer patients.
Writing in the British Medical Journal, Michael Dixon, consultant surgeon at Edinburgh Breast Unit, and David Montgomery, clinical research fellow at Glasgow Royal Infirmary, argue that the guidelines issued by the National Institute for Health and Clinical Excellence (NICE) do not meet their stated aims.
The guidelines aim to detect and treat local recurrence of cancer, deal with adverse effects of treatment, and provide psychological support. They suggest that routine long-term follow-up is "ineffective and unwarranted" and that the aims can be met by two to three years of follow-up.
However, Mr Dixon and Mr Montgomery point out that 70 per cent of cases of local recurrence of breast cancer occur after the first three years, and that the annual incidence of treatable disease recurrence remains constant for at least the first ten years.
They argue: "If NICE is to achieve its aim of detecting and treating local recurrence it clearly cannot be achieved with a three-year follow-up.
"Patients' needs vary, so follow-up programmes for patients with breast cancer need to be evidence-based, flexible, and tailored to their lifelong needs."
The experts recommend that breast cancer survivors undergo clinical examination every year for two years, followed by fully funded mammograms thereafter.
They also call for ongoing psychological support and direct access to a named breast care nurse, specialist nurse or doctor in between mammogram visits, as well as access to prosthesis advice and fitting.
Catherine Foot, Cancer Research UK's head of policy, said: "Every woman who has been treated for breast cancer deserves the best possible follow-up care. Unfortunately, the quality of follow-up services in the UK varies and this needs to be addressed.
Ms Foot noted: "There has been some improvement but as more and more people are surviving cancer the NHS can and should get better at supporting patients in the long-term, not only during treatment.
"We know that almost two-thirds of women with breast cancer now survive for at least 20 years. So it is vital for all patients to have access to high quality follow-up services that are tailored to the individual's needs for many years after treatment."
More than 44,100 people are diagnosed with breast cancer each year in the UK and the disease can recur even after 20 to 30 years.
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