Follow-up of patients with early breast cancer: Is it time to rewrite the story?

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Abstract

The guidelines for follow-up in breast cancer survivors support only performance of periodic physical examination and annual mammography. However, medical oncologists and primary care physicians routinely recommend both blood tests and non-mammographic imaging tests in asymptomatic patients, leading to an increased anxiety related to false-positive results and higher medical expenses. Recently, advanced imaging technologies have improved sensitivity/specificity to detect metastatic lesions before symptoms arise. Considering the progress made in the treatment of metastatic disease and the rapid evolution of targeted therapy, that requires customization of the strategy according to molecular characteristics of the disease, patients could derive real benefit to early detection of disease recurrence. This hypothesis must be tested in a prospective clinical trial.

Keywords

Early breast cancer
Follow-up
Surveillance
Survivorship care

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Fabio Puglisi (MD, PhD) is researcher and professor of Medical Oncology at the University of Udine, Italy and senior staff member of the Department of Medical Oncology, University Hospital of Udine, Italy. Since 1998, prof. Puglisi has held his teaching activity mainly for the University of Udine, Italy and in regional and national courses. He is author of several publications in scientific peer-reviewed journals, especially in his main fields of interest (i.e. clinical trials on breast cancer treatment and research on prognostic and predictive factors). He is an active member of International Breast Cancer Study Group (IBCSG), Michelangelo Foundation, Gruppo Italiano Mammella (GIM). Puglisi is also national treasurer of Italian Association of Medical Oncology (AIOM). As an expert on clinical trials in oncology, he served on the Board of the Ethical Committee of the General Hospital of Trieste, Italy.

Caterina Fontanella received her Medical Degree in 2010 from the University of Trieste, Italy. Since 2011, Dr. Fontanella works as postgraduate student at the Department of Medical Oncology, University Hospital of Udine, Italy. To date, she is a fellowship researcher at the German Breast Group institute in Neu-Isenburg, Germany. Dr. Fontanella is the co-author of different publications in peer-reviewed journals and she is a member of Italian Association of Medical Oncology (AIOM).

Gianmauro Numico is Head of the Medical Oncology Unit of the “Azienda USL della Valle d’Aost”, Aosta, Italy. He is the coordinator of the working group on cancer follow up of the Italian Association of Medical Oncology (AIOM) and is the reference in the Piemonte and Valle d’Aosta Oncological network. Survivorship care is one of his main field of interest.

Valentina Sini received her Medical Degree in 2006 from “Tor Vergata” University of Rome, Italy. In 2011 she specialized in Oncology, “Tor Vergata” University of Rome. Since 2011 she is a PhDs in PhD University Grant Program “Clinical and Experimental Research Methodologies in Oncology” provided by the Faculty of Medicine and Psychology, “Sapienza” University of Rome. She is an assistant at the Oncology Unit, Department of Oncology “Sant’Andrea” Hospital of Rome. She authored/coauthored different papers published in peer-reviewed international journals. Current areas of research include new treatments of breast cancer, cardiac and endocrine-related toxicity of targeted and cytotoxic agents, optimization of endocrine therapy in breast cancer.

Laura Evangelista, MD PhD, is a nuclear medicine physician at Istituto Oncologico Veneto IOV–IRCCS Padova, Italy. Following her residency in Nuclear Medicine at University “Federico II” of Napoli Italy, she worked as research fellow at University “Federico II” of Napoli Italy (from January 2009 to June 2009) and Memorial Sloan Kettering of New York City, USA (from January 2011 to April 2011) focusing on PET/CT in breast cancer and molecular imaging. Moreover, in 2009 she moved at Istituto Oncologico Veneto IOV – IRCCS Padova, Italy, where she is currently working as a nuclear medicine physician, with a special interest in the nuclear diagnostic evaluation of breast cancer.

Francesco Monetti received his M.D. degree with full marks from the University of Genoa, Italy in 1996. He took the specialty in Radiology in 2000 at the University of Genoa. He worked as radiologist in the Department of Radiology, Breast Imaging Section, San Martino Hospital - IST-National Cancer Institute, Genoa since 2001 until now. He is also the Quality Manager of the department since 2011. He was Radiology Reviewer for EORTC in EORTC phase II study: The activity of raltitrexed (Tomudex) in malignant pleural mesothelioma. He is OECI auditor since 2013. He is member of Italian Society of Medical Radiology (S.I.R.M.).

Stefania Gori is currently Director of the Medical Oncology Division in the Department of Oncology at the Sacro Cuore – Don Calabria Hospital, Negrar, Verona, Italy. She specializes in Internal Medicine and in Medical Oncology. Stefania Gori's research interests include experimental studies on basic and clinical applied research on breast cancer. She has been the Principal Investigator of many industry-sponsored clinical trials. Stefania Gori is a member of numerous scientific societies, including the Italian Association of Medical Oncology (AIOM), the European Society of Medical Oncology (ESMO), and the American Society of Clinical Oncology (ASCO). She is the author or co-author of more than 60 publications in peer-reviewed journals.

Lucia Del Mastro received his M.D. degree with full marks and honours from the University of Naples, Italy in 1989. She took the specialty in Medical Oncology in 1993 at the University of Naples. She is the director of the S.S. Sviluppo Terapie Innovative at the IRCCS AOU San Martino-IST Hospital in Genoa, Italy. She is principal investigator of phase II and III trials in metastatic and early breast cancer patients, and principal investigator of toxicity and supportive care studies. She is reviewer of international papers for many scientific journals such as: Annals of Oncology, The Lancet, Journal of Clinical Oncology, Cancer Research and The Oncologist. She is reviewer of research projects for Cancer Research UK and European Organization for Research and Treatmemt of Cancer (EORTC). She is member of the Scientific Committee of GIM (Gruppo Italiano Mammella). She is the chairperson of the steering committee of the AIOM (Associazione Italiana Oncologia Medica) recommendations for fertility preservation in cancer patients and she is a member of the steering committee of the AIOM recommendations for the management of breast cancer patients.