Follow-Up of Long-Term Survivors
There is no consensus among oncologists as to the optimal follow-up routine for long-term breast cancer survivors. Based on guidelines from the National Comprehensive Cancer Network, patients with stage 0 breast cancer should undergo a medical history and physical examination every 6 months for 5 years and then annually thereafter; mammography should be performed every year. Patients with stage I breast cancer should undergo a medical history and physical examination every 4 to 6 months for 5 years and then annually thereafter. In stage I patients, mammography should be performed every 6 months in the ipsilateral breast after radiation therapy following breast-conserving surgery. Thereafter, it can be done annually. If mastectomy was performed, mammography should be performed annually in the contralateral breast. Women receiving tamoxifen(Drug information on tamoxifen) should undergo pelvic examination every 12 months if the uterus is present. All other follow-up evaluations are dictated by the development of symptoms.
The Women's Intervention Nutrition Study tested the effect of a dietary intervention in women with resected, early-stage breast cancer receiving conventional cancer management. Interim results showed that reduced dietary fat intake, with modest influence on body weight, may improve relapse-free survival. In all, 2,437 women were randomly assigned to a dietary intervention (n = 975) or a control (n = 1,462) group. After a median follow-up of 60 months, dietary fat intake was lower in the intervention group than in the control group (33.3 vs 51.3 fat grams/day at 12 months, respectively), corresponding to a statistically significant (P = .005), 6-pound-lower mean body weight in the intervention group. A total of 277 relapse events (local, regional, distant, or ipsilateral breast cancer recurrence or new contralateral breast cancer) have been reported in the dietary group (9.8%) and in the control group (12.4%). The HR of relapse events in the intervention group compared with the control group was 0.76.
Kwan et al assessed the association of alcohol(Drug information on alcohol) consumption on breast cancer prognosis in the Life After Cancer Epidemiology (LACE) study. Included in the study were 1,897 early-stage breast cancer patients between 18 and 70 years of age, who completed treatment except for adjuvant hormonal therapy and were free of recurrence. Alcohol consumption was assessed on average 2 years after breast cancer diagnosis. A total of 51% of the participants were considered drinkers (> 0.5 g/d of alcohol), and the majority drank wine (89%). With a median follow-up of 7.4 years, participants who consumed ≥ 6 grams of alcohol per day were found to have an increased risk of both breast cancer recurrence (HR, 1.35; 95% CI, 1–1.83) and risk of death from breast cancer (HR, 1.51; 95% CI, 1–2.29) compared with nondrinkers. Furthermore, the increased risk of recurrence appeared to be greater among postmenopausal (HR, 1.51; 95% CI, 1.05–2.19) and overweight and obese women (HR, 1.60; 95% CI, 1.08–2.38). However, there was no association found with all-cause death and there appeared to be a reduction in risk of non-breast-cancer death. The investigators concluded that regular alcohol consumption of four or more alcoholic drinks per week after a breast cancer diagnosis may increase the risk of breast cancer recurrence as well as death from breast cancer, especially among postmenopausal overweight/obese women, but has no apparent impact on overall risk of death.