Evaluating theAge-BasedRecommendations forLong-Term Follow-Upin Breast Cancer

Annemieke Witteveen*, Linda de Munck, Catharina G. M. Groothuis-Oudshoorn, Gabe S. Sonke, Philip M. Poortmans, Liesbeth J. Boersma, Marjolein L. Smidt, Ingrid M. H. Vliegen, Maarten J. IJzerman, Sabine Siesling

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

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.

Original languageEnglish
Pages (from-to)E1330-E1338
Number of pages9
JournalOncologist
Volume25
Issue number9
DOIs
Publication statusPublished - Sep 2020

Keywords

  • Breast cancer
  • Risk-based follow-up
  • Locoregional recurrence
  • Second primary
  • Thresholds
  • CONSERVING TREATMENT
  • TUMOR RECURRENCE
  • RISK-FACTORS
  • WOMEN
  • RELAPSE
  • CARE
  • RECEPTOR
  • YOUNGER
  • IMPACT

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