Marta Bonotto
Department of Oncology University Hospital of Udine
EARLY BREAST CANCER:
Guidelines for FOLLOW‐UP
GOOD HEALTH
SECOND PRIMARY CANCERS
BREAST CANCER RECURRENCES COMPLIANCE
THERAPY‐
RELATED
COMPLICATION
Interventi
CLINICAL VISIT
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
Interventi
CLINICAL VISIT
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
BREAST CANCER
Interventi
CLINICAL VISIT
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
“ […] The history and physical examination should be
performed by a physician experienced in the surveillance
of patients with cancer e in breast examination […]”
Interventi
CLINICAL VISIT
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
➖ NURSE‐LED TELEPHONE FOLLOW‐UP
➖ POINT‐OF‐NEED ACCESS TO SPECIALIST CARE
➕ MORE INTENSIVE FOLLOW‐UP (additional imaging and laboratory tests)
➕ CANADIAN SURVIVORSHIP CARE PLAN
Reduced follow‐up strategies did not affect outcomes
BREAST CANCER
Interventi
CLINICAL VISIT
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
➖ NURSE‐LED TELEPHONE FOLLOW‐UP
➖ POINT‐OF‐NEED ACCESS TO SPECIALIST CARE
➕ MORE INTENSIVE FOLLOW‐UP (additional imaging and laboratory tests)
➕ CANADIAN SURVIVORSHIP CARE PLAN
Interventi
CLINICAL VISIT
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
“ […] The history and physical examination should be performed by a physician experienced in the surveillance of patients with cancer e in breast examination […]”
“[…] Trasferring to primary care physicians was considered an important strategy […]”
BREAST CANCER
“[…] approximately 1 yr after diagnosis[…]”
Interventi
CLINICAL VISIT
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
“ […] The history and physical examination should be performed by a physician experienced in the surveillance of patients with cancer e in breast examination […]”
“[…] Trasferring to primary care physicians was considered an important strategy […]”
Numico G, Pinto C, Gori S, Ucci G, Di Maio M, et al. (2014)
BREAST CANCER 1,951 pts with BC N0
Overall BC‐related event rate of 20‐30% at 10 years
1,951 pts with BC N0
Overall BC‐related event rate of 20‐30% at 10 years
GOOD HEALTH
SECOND PRIMARY CANCERS
BREAST CANCER RECURRENCES COMPLIANCE
THERAPY‐
RELATED COMPLICATION
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
BREAST CANCER
Numico G, Pinto C, Gori S, Ucci G, Di Maio M, et al. (2014)
“74% of Italian oncologists report to adopt institutional guidelines for follow up breast”
“they routinary ask for
”
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
BREAST CANCER
Liver tests 80% FP
Alkaline phosphatase 28% FP, 50% FN
Bone scan sn 86%, sp 81% for bone metastases
Chest imaging 9/416 (1/46) had isolated lung metastases
Liver ultrasound 84% FP
Abdominopelvic CT scan 0.5% had pelvic metastatic disease
PET scanning more sensitive but unknown effect
on mortality and QoL
Liver tests 80% FP
Alkaline phosphatase 28% FP, 50% FN
Bone scan sn 86%, sp 81% for bone metastases
Chest imaging 9/416 had isolated lung metastases
Liver ultrasound 84% FP
Abdominopelvic CT scan 0.5% had pelvic metastatic disease
PET scanning more sensitive but unknown effect on mortality and QoL
EARLY DIAGNOSIS OF ASYMPTOMATIC METASTATIC DISEASE
DOES NOT IMPROVE SURVIVAL
BREAST CANCER
Liver tests 80% FP
Alkaline phosphatase 28% FP, 50% FN
Bone scan sn 86%, sp 81% for bone metastases
Chest imaging 9/416 had isolated lung metastases
Liver ultrasound 84% FP
Abdominopelvic CT scan 0.5% had pelvic metastatic disease
PET scanning more sensitive but unknown effect on mortality and QoL
EARLY DIAGNOSIS OF ASYMPTOMATIC METASTATIC DISEASE
DOES NOT IMPROVE SURVIVAL
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
BREAST CANCER Guidelines of ASCO 1997:
CEA as a marker for Breast Cancer: is not recommended Guidelines of ASCO 2000:
No change
Guidelines of ASCO 1997:
Data are insufficient to recommend Ca 15‐3 for surveillance […]
Guidelines of ASCO 2000:
No change
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2014
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk*
pts at high risk periodic
BREAST CANCER Mammography in asymptomatic patients Absolute reduction in
mortality: 17‐28%
Low specificity As per ACS
Guidelines Young patients,
Genetic or familiar predisposition
*ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2014
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk*
pts at high risk periodic
Low specifity According to US
Preventive Services Task Force
Young patients,
Genetic or familial
predisposition
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING GYNECOLOGIC
ASSESSMENT
AIOM ‐2014
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING GYNECOLOGIC
ASSESSMENT
AIOM ‐2014
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified Annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST IMAGING TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended not recommended every 12 months
particular cases not specified annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
not recommended not recommended not recommended every 12 months
pts at high risk pts at high risk
periodic
BREAST CANCER
CA 125
elevated in 50 to 90 percent of women with early ovarian cancer, elevated in numerous other conditions.
Screening with measurement of CA 125 is not recommended, either in average‐ or high‐risk women
Transvaginal ultrasonography (TVUS)
when used as a sole screening intervention, has not been effective in
identifying early‐stage cancer.
GOOD HEALTH
SECOND PRIMARY CANCERS
BREAST CANCER RECURRENCES COMPLIANCE
THERAPY‐
RELATED
COMPLICATION
BREAST CANCER TAMOXIFEN vs. no adjuvant [from 20 trials‐analysis of individual patients] :
2.4‐fold increased risk of uterine cancer
No effect on mortality
Very slow increased incidence of uterine sarcoma (carcinosarcoma or malignant mixed Mullerian Tumors)
o Annual gynecologic examination is recommended o Thorough evaluation of abnormal bleeding
o Utility of transvaginal ultrasound is unproven
247 asymptomatic women receiving TAM transvaginal ultrasound q 6 months
After 3 y: Endometrial thickness: 3.5 mm 9.2 mm Cut‐off 10 mm High FP
Substantial iatrogenic morbidity
GOOD HEALTH
SECOND PRIMARY CANCERS
BREAST CANCER RECURRENCES COMPLIANCE
THERAPY‐
RELATED
COMPLICATION
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT CARDIAC FUNCTION
SCREENING DEXA SCAN
AIOM ‐2015
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
During AI not recommended
every 12 months BRCA 1‐2 m family history
regularly yes basal, periodic
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended
every 12 months particular cases
not specified
annual during TAM
yes Regular, on AI
ASCO ‐ 2013
Every 3‐6 months (0‐3 y) Every 6‐12 months (4‐5 y)
Every 12 months (>5 y)
as primary care not recommended
every 12 months pts at high risk pts at high risk
periodic as primary care basal, every 2 y
Interventi
CLINICAL VISIT
LABORATORY TEST TUMOR MARKERS
MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT CARDIAC FUNCTION
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
During AI not recommended
every 12 months BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended
every 12 months particular cases
not specified annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
as primary care not recommended
every 12 months pts at high risk pts at high risk
periodic
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT CARDIAC FUNCTION
SCREENING DEXA SCAN
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
During AI not recommended
every 12 months BRCA 1‐2 m family history
regularly yes basal, periodic
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended
every 12 months particular cases
not specified
annual during TAM
yes Regular, on AI
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
as primary care not recommended
every 12 months pts at high risk pts at high risk
periodic as primary care
basal, every 2 y
o Incidence of clinical congestive heart failure <5%
o may take years
o Reversible vs. irreversible
o Looking for cardioprotective medications
o Having a history of anthracycline exposure plus additional
cardiovascular risk factors increases the risk for progressive heart failure
PRINCIPLES OF ANTHRACYCLINE‐INDUCED CARDIAC TOXICITY
BREAST CANCER
Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. 2012
Patients receiving anthracyclines and/or trastuzumab serial monitoring of cardiac function
at baseline, 3, 6 and 9 months during treatment, then at 12 and 18 months
Increased vigilance is recommended for patients ≥60 years old
BREAST CANCER
Cardiotoxicity – LV Dysfunction Problems with Ejection Fraction
• Operator dependent
‐ significant interobserver variability (10‐20%)
• Ejection Fraction and Contractility
‐ A load dependent measurement influenced by preload and afterload
• Insensitive marker for early cardiotoxicity
‐ Appreciate amount of myocardial damage
has to occurr before a change in EF is
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT CARDIAC FUNCTION
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
During AI not recommended
every 12 months BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended
every 12 months particular cases
not specified annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
as primary care not recommended
every 12 months pts at high risk pts at high risk
periodic
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT CARDIAC FUNCTION
SCREENING DEXA SCAN
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
During AI not recommended
every 12 months BRCA 1‐2 m family history
regularly not specified basal, periodic
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended
every 12 months particular cases
not specified
annual during TAM
not specified Regular, on AI
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
as primary care not recommended
every 12 months pts at high risk pts at high risk
periodic as primary care basal, every 2 y*
*ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
• Post‐menopausal
• Pre‐menopausal and risk factor for osteoporosis
• Post‐menopausal
• Pre‐menopausal and risk factor for osteoporosis
• > 65 y
• 60‐65 y and risk factors for osteoporosis
• Post‐menopausal and AI
• Premature menopause
• > 65 y
• 60‐65 y and risk factors for osteoporosis
• Post‐menopausal and AI
• Premature menopause
GOOD HEALTH
SECOND PRIMARY CANCERS
BREAST CANCER RECURRENCES COMPLIANCE
THERAPY‐
RELATED
COMPLICATION
BREAST CANCER Body image concerns
Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
Body image concerns Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
BREAST CANCER Body image concerns
Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
Body image concerns Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
BREAST CANCER Body image concerns
Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
Body image concerns Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
BREAST CANCER Body image concerns
Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
BODY MASS INDEX AND CANCER MORTALITY
BREAST CANCER Body image concerns
Lymphedema
Cognitive impairment
Distress, depression, anxiety Fatigue
Musculoskeletal health Pain and neuropathy
Infertility
Sexual health Obesity
Physical activity Nutrition
Smoking cessation Information
ACS/ASCO BrCa Survivorship Guideline. J Clin Oncol 2015
MULTIDISCIPLINARY TEAM
Specialised breast nurse
GOOD HEALTH
SECOND PRIMARY CANCERS
BREAST CANCER RECURRENCES COMPLIANCE
THERAPY‐
RELATED COMPLICATION
BREAST CANCER
Interventi
CLINICAL VISIT
LABORATORY TEST TUMOR MARKERS MAMMOGRAPHY MRI of the breast
GENETIC COUNSELING
GYNECOLOGIC ASSESSMENT CARDIAC FUNCTION
AIOM ‐2015
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
During AI not recommended
every 12 months BRCA 1‐2 m family history
regularly
ESMO ‐ 2015
Every 3‐4 months (0‐2 y) Every 6 months (3‐5 y) Every 12 months (>5 y)
during ET not recommended
every 12 months particular cases
not specified annual during TAM
ASCO ‐ 2013
Every 3‐6 months (0‐3) Every 6‐12 months (4‐5)
Every 12 months (>5)
as primary care not recommended
every 12 months pts at high risk pts at high risk
periodic
