Follow-up strategies for women treated for early breast cancer

 

Abstract

Background

Follow-up examinations are commonly performed after primary treatment for women with breast cancer. They are used to detect recurrences at an early (asymptomatic) stage.

Objectives

To assess the effectiveness of different policies of follow-up for distant metastases on mortality, morbidity and quality of life in women treated for stage I, II or III breast cancer.

Search methods

We searched, the Breast Cancer Group's specialized register (May 14, 2004), the Cochrane Controlled Trial Register (Cochrane Library Issue 1, 2004), Medline (January 1966 - May 2004) and EMBASE (1988 - May 2004). References from retrieved articles were also checked.

Selection criteria

All randomised controlled trials (RCTs) assessing the effectiveness of different policies of follow-up after primary treatment were reviewed for inclusion.

Data collection and analysis

Two reviewers independently assessed trial quality and eligibility for inclusion in the review. Data were pooled in an individual patient data meta-analysis for the two RCTs testing the effectiveness of different follow-up schemes. Subgroup analyses were conducted by age, tumour size and lymph node status.

Main results

Four RCTs involving 3055 women with breast cancer (clinical stage I, II or III) were included. Two of these involving 2563 women compared follow-up based on clinical visits and mammography with a more intensive scheme including radiological and laboratory tests. After pooling the data, no significant differences in overall survival (hazard ratio 0.96, 95% confidence interval 0.80 to 1.15) or disease-free survival (hazard ratio 0.84, 95% confidence interval 0.71 to 1.00) emerged. No differences in overall survival and disease-free survival emerged in subgroup analyses according to patient age, tumour size and lymph node status before primary treatment. In 1999, 10-year follow-up data became available for Rosselli Del Turco and no significant differences in overall survival were found.

One RCT (296 women) compared follow-up performed by a hospital-based specialist to follow-up performed by general practitioners. No significant differences in time to detection of recurrence and quality of life emerged. Patient satisfaction was greater among patients treated by general practitioners.
One RCT (196 women) compared regularly scheduled follow-up visits to less frequent visits restricted to the time of mammography. No significant differences emerged in interim use of telephone and frequency of GP's consultations.

Authors' conclusions

This updated review of RCTs conducted almost 20 years ago suggest that follow-up programs based on regular physical examinations and yearly mammography alone are as effective as more intensive approaches based on regular performance of laboratory and instrumental tests in terms of timeliness of recurrence detection, overall survival and quality of life.

In one RCT, follow-up care performed by trained general practitioners working in an organized practice setting had comparable effectiveness to that delivered by hospital-based specialists in terms of quality of life and time to detection of distant metastases.

 

Plain language summary

The recent update confirms that a regular physical and yearly mammogram are as effective as more intense methods of examination in detecting recurrent breast cancer.

Follow-up examinations are common for women after primary treatment for breast cancer. This is done to detect recurrences at an early stage and begin treatment for any relapses quickly. These tests can include liver scans, tumour markers, chest x-rays and blood and liver function tests. The review of trials found that follow-up programs based on a regular physical exam and yearly mammogram appear to be as effective as the more intensive approaches. This was measured by detection of recurrences of cancers, overall survival and quality of life.

 

摘要

背景

早期乳癌婦女治療後追蹤策略

追蹤檢查常用於已完成主要治療的乳癌婦女,用以偵測早期(無症狀)復發的可能性.

目標

本篇文獻回顧的目標在於針對罹患第I, II或III期的乳癌婦女,評估不同治療後追蹤策略的效度,包括追蹤遠處轉移的發生率、死亡率，以及乳癌婦女的生活品質.

搜尋策略

我們搜尋了the Breast Cancer Group's specialized register (May 14, 2004), the Cochrane Controlled Trial Register (Cochrane Library Issue 1, 2004), Medline (January 1966 – May 2004) 及 EMBASE (1988  May 2004).文獻中所列的參考資料也一併查閱..

選擇標準

所有在主要療程後評估不同治療後追蹤策略的隨機對照試驗(RCTs)均被審閱,以評估是否合乎納入標準.

資料收集與分析

有兩位審閱者分開獨立審閱試驗的品質及可行性.將所取得的資料進行個別病患資料大量分析,以評估兩個隨機對照試驗(RCTs)的效度及追蹤方案.此外,也針對年齡、腫瘤大小,以及淋巴結狀況進行子群體分析.

主要結論

本篇回顧共納入四個隨機對照試驗(RCTs),3,055位罹患乳癌的婦女(臨床分期 I, II 或 III).比較其中兩個試驗包括2,563位婦女的臨床後續追蹤,以及較為密集的乳房攝影追蹤計畫,包括放射線檢查及檢驗室檢查.分析資料後顯示,兩者之間的整體存活率並無顯著差異(有害比率為0.84,95%信賴區間為0.71至1.00). 根據分析子群體接受主要治療前的年齡、腫瘤大小,以及淋巴結狀況, 整體存活率並無顯著差異.在1911年, Rosselli Del Turco可取得十年的追蹤資料,但未發現整體存活率有所不同.一項隨機對照試驗(296位婦女)針對醫院專家與一般醫療執業人員比較其後續追蹤的效果,在發現復發的時間與生活品質方面均無顯著差異. 但接受一般醫療執業人員追蹤的病患,有較高的滿意度.另一項隨機對照試驗(196位婦女)針對規律追蹤乳房攝影與較不規律追蹤者做比較.追蹤期間使用電話追蹤或婦科專業人員諮詢並無顯著差異.

作者結論

此篇最新的回顧的隨機對照試驗(RCTs)幾乎為20年前所執行,結果顯示乳癌婦女的追蹤計畫,不論是規律的身體檢查及每年僅作乳房攝影,或是採行較密集的方式檢驗或儀器檢查,對於復發的偵測時間及偵測率、整體存活率,或是生活品質,均無顯著差異.一項隨機對照試驗(RCTs)結果顯示,由訓練有素的一般醫療執業人員在良好的職業環境中進行追蹤,對於病患的生活品質與偵測遠端轉移的結果,和醫院專家進行追蹤有類似的成效.

翻譯人

本摘要由國泰綜合醫院劉怡敏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

最新的資料顯示,進行規律性身體檢查,以及每年進行乳房攝影,與進行密集的檢查一樣,對於偵測乳癌復發的效果相同.乳癌婦女在主要治療之後進行追蹤檢查是很普遍的,其有利於偵測早期轉移,並可迅速進行治療.這些追蹤檢查可包括肝臟掃描、腫瘤標記、胸部X光、血液檢查,以及肝功能檢驗.試驗回顧發現規律性身體檢查及每年進行乳房攝影,與較頻繁密集的追蹤效果相當.其由評估偵測復發率、整體存活率,以及生活品質而得此結論.