The Mayo Clinic Breast Cancer Book by Mayo Clinic & Charles L. Loprinzi M.D

Author:Mayo Clinic & Charles L. Loprinzi M.D. [Hartmann M.D., Lynne C.]
Language: eng
Format: epub
Publisher: RosettaBooks
Published: 2012-11-16T16:00:00+00:00

These tests were once more commonly performed in an effort to detect a cancer recurrence before it produced signs and symptoms. But there’s no evidence — despite multiple studies — that the tests prolong survival or improve quality of life. That is why these tests aren’t recommended by the American Society of Clinical Oncology.

In addition, these tests aren’t always accurate — they may miss signs of a recurrence or, just the opposite, suggest cancer is there when none exists. Test results that are wrong or inconclusive can cause a lot of needless stress and anxiety and create the need for additional testing.

A look at the research

A number of investigations have been done to try to assess the role of intensive testing in the routine follow-up care of women with no evidence of breast cancer after treatment. So far, the evidence indicates that such testing doesn’t have a significant effect in helping to prolong survival or improve quality of life.

Key studies

The strongest evidence against most follow-up tests comes from two large Italian studies that focused on intensive screening for breast cancer recurrences.

In the first study, 622 women had intensive follow-up testing including regular physical exams and yearly mammograms, plus chest X-rays and bone scans every six months. An additional 621 women followed the same schedule for physical exams and yearly mammograms, but received no other tests. This was known as the clinical follow-up group. The investigators found that even though cancer that recurred in bone and the lungs was detected earlier in the intensive testing group, there was no difference between the two groups in the detection of metastatic recurrences at other sites or in the detection of local and regional recurrences. And most importantly, there was no improvement in survival 10 years later. The conclusion was that intensive follow-up with chest X-rays and bone scans doesn’t offer any survival advantage to women with breast cancer.

In the second study, 655 women had intensive testing consisting of regular physical exams, yearly mammograms and bone scans, liver ultrasounds, chest X-rays, and blood tests every six months. Another 665 women were enrolled in clinical follow-up consisting of regular physical exams and yearly mammograms only. After six years, there was no significant difference in death rates between the two groups. The trial also measured quality of life and found no difference there either.

Blood tumor markers

Tumors can sometimes make unique proteins or other substances that can be measured in the bloodstream. These are usually referred to as tumor markers. To date, there’s no ideal tumor marker or combination of markers that’s specific for breast cancer, but some markers may suggest the presence of breast cancer. Examples include CA 15-3, CA 27-29 and carcinoembryonic antigen (CEA).

The question arises: Would these blood tests be helpful in detecting recurrent breast cancer? Currently, no available data suggest that the tests are accurate enough to detect a cancer recurrence early enough to improve a woman’s chances of survival.

In addition, these substances also exist in healthy people who don’t have cancer, meaning

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