RECOMMENDED BREAST-CANCER SURVEILLANCE GUIDELINES

Objective: To determine an effective, evidence-based postoperative sur veillance strategy for the detection and treatment of recurrent breast cancer. Tests are recommended only if they have an impact on the outc omes specified by the American Society of Clinical Oncology (ASCO) for clinical practice guidelines. Potential lntervention: All tests descr ibed in the literature for postoperative monitoring were considered. I n addition, the data were critically evaluated to determine the optima l frequency of monitoring. Outcome: Outcomes of interest include overa ll and disease-free survival, quality of life, toxicity reduction, and secondarily cost-effectiveness. Evidence: A search was performed to d etermine all relevant articles published over the past 20 years on the efficacy of surveillance testing for breast cancer recurrence. These publications comprised both retrospective and prospective studies. Val ues: Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis tha t directly related testing to one of the primary outcomes in a randomi zed design. Benefits/Harms/Costs: The possible consequences of false-p ositive and negative tests were considered in evaluating a preference for one of two tests that provided similar information, Cost alone was not a determining factor. Recommendations: The attached guidelines su mmarize the recommendations of the ASCO breast cancer expert panel (se e Table 1 for a summary of guidelines and corresponding levels of evid ence and grades of recommendation). Data are sufficient to recommend m onthly breast self-examination, annual mammography of the preserved an d contralateral breast, and a careful history and physical examination every 3 to 6 months for 3 years, then every 6 to 12 months for 2 year s, then annually, Data are not sufficient to recommend routine bone sc ans, chest radiographs, hematologic blood counts, tumor markers (CEA, CA15-5), liver ultrasonograms, or computed axial tomographic scans. Va lidation: The recommendations of the breast cancer expert panel were e valuated by the ASCO Health Services Reserach Committee reviewers and by the ASCO Board of Directors. Sponsor: American Society of Clinical Oncology. (C) 1997 by American Society of Clinical Oncology.