American Society of Clinical Oncology 1998 update of recommended breast cancer surveillance guidelines

Objective: To determine an effective, evidence-based, postoperative surveil lance strategy for the detection and treatment of recurrent breast cancer. Tests are recommended only if they have an impact on the outcomes specified by American Society of Clinical Oncology (ASCO) for clinical practice guid elines. Potential Intervention: All tests described in the literature for postopera tive monitoring were considered, In addition, the data were critically eval uated to determine the optimal frequency of monitoring. Outcome: Outcomes of interest include overall and disease-free survival, qu ality of life, toxicity reduction, and secondarily cost-effectiveness. Evidence: A search wets performed to determine all relevant articles publis hed over the past 20 years on the efficacy of surveillance testing for brea st cancer recurrence. These publications comprised both retrospective and p rospective studies. Values: Levers of evidence and guideline grades were rated by a standard pr ocess. More weight was given to studies that tested a hypothesis directly r elating testing to one of the primary outcomes in a randomized design. Benefits, Harms, and Costs: The possible consequences of false-positive and -negative tests were considered in evaluating ct preference for one of two tests providing similar information. Cost alone was not a determining fact or. Recommendations: The attached guidelines and text summarize the updated rec ommendations of the ASCO breast cancer expert panel, Data are sufficient to recommend monthly breast self-examination, annual mammography of the prese rved and contralateral breast, and a careful history and physical examinati on every 3 to 6 months for 3 years, then every 6 to 12 months for 2 years, then annually. Data are not sufficient to recommend routine bone scans, che st radiographs, hematologic blood counts, tumor markers (carcinoembryonic a ntigen, cancer antigen [CA] 15-5, and CA 27.29), liver ultrasonograms, or c omputed tomography scans. Validation: The recommendations of the breast cancer expert panel were eval uated and supported by the ASCO Health Services Research Committee reviewer s and the ASCO Board of Directors. Sponsor American Society of Clinical Oncology. (C) 1999 by American Society of Clinical Oncology.