TY - JOUR
T1 - Evaluating theAge-BasedRecommendations forLong-Term Follow-Upin Breast Cancer
AU - Witteveen, Annemieke
AU - de Munck, Linda
AU - Groothuis-Oudshoorn, Catharina G. M.
AU - Sonke, Gabe S.
AU - Poortmans, Philip M.
AU - Boersma, Liesbeth J.
AU - Smidt, Marjolein L.
AU - Vliegen, Ingrid M. H.
AU - IJzerman, Maarten J.
AU - Siesling, Sabine
N1 - Funding Information:
We thank the registrars of the Netherlands Cancer Registry for their effort in gathering the data essential to this study. The authors had consent from the Advisory Committee of the Netherlands Comprehensive Cancer Organisation (IKNL). The study did not need approval of the Medical Ethical Committee (METc) because there was no direct patient contact, and according to local regulations in The Netherlands (WMO), only studies with high burden for patients have to be reviewed.
Publisher Copyright:
© 2020 The Authors. The Oncologist published by Wiley Periodicals LLC on behalf of AlphaMed Press.
PY - 2020/9
Y1 - 2020/9
N2 - 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.
AB - 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.
KW - Breast cancer
KW - Risk-based follow-up
KW - Locoregional recurrence
KW - Second primary
KW - Thresholds
KW - CONSERVING TREATMENT
KW - TUMOR RECURRENCE
KW - RISK-FACTORS
KW - WOMEN
KW - RELAPSE
KW - CARE
KW - RECEPTOR
KW - YOUNGER
KW - IMPACT
U2 - 10.1634/theoncologist.2019-0973
DO - 10.1634/theoncologist.2019-0973
M3 - Article
C2 - 32510767
SN - 1083-7159
VL - 25
SP - E1330-E1338
JO - Oncologist
JF - Oncologist
IS - 9
ER -