Breast cancer monitoring can be much less complex and better adapted

& # 39; More custom-made & # 39;

Follow-up can be tailored to the risk of recurrence of the disease, so low-risk women may need to visit the hospital less often for a picture of the breast (mammogram) . Tailored follow-up avoids unnecessary burden for the patient, health care providers and the health budget. For example, patients at high risk may receive more checks if needed. After proper consultation between the doctor and the patient, follow-up visits are less frequent.

Treatments improve

In the Netherlands, nearly 50 women are told each day that they have breast cancer and this number is increasing. In contrast, the number of women who die of breast cancer is decreasing. This is because treatments improve and we discover it sooner. After breast cancer treatment, women run the risk of seeing the disease return. This is called a recurrence. Within ten years of treatment, about 4% of women will experience a recurrence in the same breast and about 5% will develop a new tumor in the other breast. The purpose of the follow-up is to detect recurrences as soon as possible because the results for the patient are better.

Difference of risk of return

Although the treatment of breast cancer is more and more personalized (tailor-made) This is not the case with the follow-up: it is still based on a consensus and n & Is not adapted to the actual risk incurred by a patient. Witteveen: "At the moment breast cancer monitoring is the same for everyone for the first five years, an annual mammogram and a physical examination.After five years, follow-up according to current guidelines depends on the However, there is a difference in the risk of return of breast cancer per patient, so it would be more logical for low-risk women to be controlled less often and high-risk women to be controlled for more than one year. five years.

Tension and Uncertainty

The study showed that women at higher risk were even less likely to be followed than women at lower risk. At present, about half of the recurrences are also found by the woman herself and not during follow-up, and although follow-up can also be reassured, having a mammogram is unpleasant and monitoring are also a source of tension and uncertainty. Thus, when women have a very low risk, they are unnecessarily burdened. In addition, care providers are also billed and costs are associated with follow-up, also for the patient. Mirjam Velting, Program Manager at the Dutch Breast Cancer Association: "Follow-up visits are not always necessary from a medical point of view, this is almost never the object of 39, a discussion with the patient, but it is also a privileged moment in a conversation between the care provider and the patient ". This is why it is important to optimize the follow-up according to the personal risk of recurrence. To determine the risk of recurrence, the Dutch Cancer Registry (NKR) was used. Almost all new cancer cases have been recorded since 1989 in the RSK. The dataset used for the study included nearly 50,000 women. In collaboration with the Dutch Center for Cancer Control (IKNL) and healthcare providers, Witteveen developed the INFLUENCE nomogram to determine the risk of recurrence.

Risk Profile

In his research, Witteveen also shows how to optimize breast cancer follow-up based on the risk of recurrence for each possible risk profile, taking into account the benefits of early detection and the disadvantages of followed, such as discomfort and tension. With this model, doctors can make informed decisions with the patient. For example, women at high risk may receive more controls if needed, while patients at lower risk would be spared from unnecessary follow-up visits.

Model

Prof. Siesling, one of the promoters of Witteveen: Together with healthcare providers, gathered in the National Consultation on Breast Cancer in the Netherlands (NABON), nurses, general practitioners and the Breast Cancer Association, we examine how this model can be developed and applied on a daily basis. Both from the calculations, by presenting the risk in an understandable way, as well as to the organization, at what time and with whom do you discuss the risk. In addition, follow-up is only one element of follow-up, which also includes attention to psychosocial complaints, for example. "