A Survivor's Follow Up Care

Mortality from breast cancer has continued to decline steadily over the past five years, and that's wonderful. With additional new treatments and more innovative ways to diagnose women earlier, we anticipate that the numbers of breast-cancer survivors will continue to grow.

The swelling ranks of survivors

On the other hand, the actual number of people being diagnosed with any stage of breast cancer is also steadily growing. These increasing numbers of cases are due in part to improved early-detection techniques, but they are mainly due to simple population growth. Baby boomers are now in midlife and they represent a huge number of people!

The baby boomers' ever-growing numbers have now forced us to recognize that oncology specialists can no longer continue to follow cancer patients for the long term. This new reality means that a survivor's continuing follow-up care is now going to be the responsibility of the patient's primary care provider (PCP), her gynecologist--and even herself.

An interesting presentation at 2011 meeting of the American Society of Clinical Oncology (ASCO) in June told about a survey that was conducted called the Survey of Physician Attitudes Regarding the Care of Cancer Survivors. Over 2,000 PCPs and over 1,000 medical oncologists responded.

Community doctors will need to pitch in

The survey results revealed that PCPs were significantly more likely than were medical oncologists to order tests on the patient because of medical/legal reasons than because the patient's physical symptoms really warranted them. Duplication of care was also an issue--who is to order the patient's mammogram? Who will make sure she gets her flu shot? Promote weight control? How about cancer prevention?

What survivors now need to know

We in the field of breast health need to impress upon community physicians the importance of learning about the up-to-date care of breast-cancer survivors. We must also teach survivors how to make sure

• that they are getting the appropriate monitoring based on their degree of breast cancer risk
• that their mammogram facility offers digital imaging
• that their facility follows the latest screening guidelines
• that the patients are themselves following the care guidelines for survivors
• that the patients are scheduling their own appointments and know when and where those will be

Extra imaging tests will not bring peace of mind

Some survivors have said to me that they don't have faith that their PCP knows how to monitor them as accurately as the oncology specialists did. This lack of confidence in the PCP makes these patients want to order a slew of imaging tests for themselves in order to restore their confidence that they are doing okay. But the way to do long-term follow-up is not by getting a bone scan, a CAT scan, tumor markers, chest x-rays, PET and CT scans. Believe it or not, these extra tests would result in about $12,000 in added health care costs and, from a screening perspective, they wouldn't even provide any valid information.

So, the sooner we ensure that community doctors are being properly trained about long-term care for breast-cancer patients, the sooner our breast-cancer survivors will have the confidence in that care that they need.