Women treated for breast cancer are not receiving the best follow-up care because guidelines are lacking, claim UK experts.
Women treated for breast cancer are not receiving the best follow-up care because guidelines are lacking, claim UK experts.
The National Institute for Health and Clinical Excellence recommends two to three years of hospital follow-up to spot new tumours or cancer recurrence.
The National Institute for Health and Clinical Excellence recommends two to three years of hospital follow-up to spot new tumours or cancer recurrence.
But surgeon Michael Dixon says in the British Medical Journal that check ups should continue for at least 10 years.
But surgeon Michael Dixon says in the British Medical Journal that check ups should continue for at least 10 years.
Nearly three quarters of the cancers occur after the first three years.
Nearly three quarters of the cancers occur after the first three years.
NICE said it was reviewing its advice and would issue new guidance early next year.
NICE said it was reviewing its advice and would issue new guidance early next year.
Breast cancer
Breast cancer
More than 1.2 million women and men are diagnosed with breast cancer each year.
More than 1.2 million women and men are diagnosed with breast cancer each year.
As screening and treatment has improved, breast cancer patients are living for longer. Follow-up is important to check for disease recurrence and provide psychological support.
As screening and treatment has improved, breast cancer patients are living for longer. Follow-up is important to check for disease recurrence and provide psychological support.
But Mr Dixon, a consultant surgeon at Edinburgh's Western General Hospital, and colleague David Montgomery from Glasgow's Royal Infirmary say protocols vary widely across the UK and current guidelines do not reflect best evidence.
But Mr Dixon, a consultant surgeon at Edinburgh's Western General Hospital, and colleague David Montgomery from Glasgow's Royal Infirmary say protocols vary widely across the UK and current guidelines do not reflect best evidence.
There is too much inconsistency across the country in the way that NICE follow-up guidelines are interpreted Anna Wood of Breast Cancer Care
There is too much inconsistency across the country in the way that NICE follow-up guidelines are interpreted Anna Wood of Breast Cancer Care
NICE guidelines say follow-up beyond three years is not justified - studies have not shown an improvement in outcomes for patients.
NICE guidelines say follow-up beyond three years is not justified - studies have not shown an improvement in outcomes for patients.
But the authors of the BMJ editorial argue that the annual incidence of treatable disease is constant at 1 to 1.5% for at least the first 10 years, and 70% of such events occur after the first three years.
But the authors of the BMJ editorial argue that the annual incidence of treatable disease is constant at 1 to 1.5% for at least the first 10 years, and 70% of such events occur after the first three years.
They say patients should be checked annually for two years and undergo regular mammography screening - breast scans - thereafter.
They say patients should be checked annually for two years and undergo regular mammography screening - breast scans - thereafter.
"Mammography is a very effective way to detect treatable local disease, and fully funded mammographic surveillance programmes specifically for patients with breast cancer are urgently needed," they said.
"Mammography is a very effective way to detect treatable local disease, and fully funded mammographic surveillance programmes specifically for patients with breast cancer are urgently needed," they said.
Follow-up programmes for patients with breast cancer patients need to be evidence based, flexible, and tailored to their lifelong needs, they said.
Follow-up programmes for patients with breast cancer patients need to be evidence based, flexible, and tailored to their lifelong needs, they said.
Anna Wood of Breast Cancer Care said: "There is too much inconsistency across the country in the way that NICE follow-up guidelines are interpreted.
Anna Wood of Breast Cancer Care said: "There is too much inconsistency across the country in the way that NICE follow-up guidelines are interpreted.
"We regularly hear from women who believe they may not be receiving the highest levels of care, which can cause them great anxiety and confusion."
"We regularly hear from women who believe they may not be receiving the highest levels of care, which can cause them great anxiety and confusion."
In particular, she said more needed to be done to meet the psychological and emotional needs of patients.
In particular, she said more needed to be done to meet the psychological and emotional needs of patients.
A NICE spokesperson said: "NICE is already reviewing these recommendations as part of its clinical guideline on the diagnosis and treatment of early breast cancer. The guideline is expected to be published in February 2009."
A NICE spokesperson said: "NICE is already reviewing these recommendations as part of its clinical guideline on the diagnosis and treatment of early breast cancer. The guideline is expected to be published in February 2009."
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