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dc.contributor.authorWitteveen, A
dc.contributor.authorde Munck, L
dc.contributor.authorGroothuis-Oudshoorn, CGM
dc.contributor.authorSonke, GS
dc.contributor.authorPoortmans, PM
dc.contributor.authorBoersma, LJ
dc.contributor.authorSmidt, ML
dc.contributor.authorVliegen, IMH
dc.contributor.authorIJzerman, MJ
dc.contributor.authorSiesling, S
dc.date.accessioned2020-11-17T03:27:26Z
dc.date.available2020-11-17T03:27:26Z
dc.date.issued2020-06-29
dc.identifier.citationWitteveen, A., de Munck, L., Groothuis-Oudshoorn, C. G. M., Sonke, G. S., Poortmans, P. M., Boersma, L. J., Smidt, M. L., Vliegen, I. M. H., IJzerman, M. J. & Siesling, S. (2020). Evaluating the Age-Based Recommendations for Long-Term Follow-Up in Breast Cancer. ONCOLOGIST, 25 (9), pp.E1330-E1338. https://doi.org/10.1634/theoncologist.2019-0973.
dc.identifier.issn1083-7159
dc.identifier.urihttp://hdl.handle.net/11343/251506
dc.description.abstractBACKGROUND: After 5 years of annual follow-up following breast cancer, Dutch guidelines are age based: annual follow-up for women <60 years, 60-75 years biennial, and none for >75 years. We determined how the risk of recurrence corresponds to these consensus-based recommendations and to the risk of primary breast cancer in the general screening population. SUBJECTS, MATERIALS, AND METHODS: Women with early-stage breast cancer in 2003/2005 were selected from the Netherlands Cancer Registry (n = 18,568). Cumulative incidence functions were estimated for follow-up years 5-10 for locoregional recurrences (LRRs) and second primary tumors (SPs). Risks were compared with the screening population without history of breast cancer. Alternative cutoffs for age were determined by log-rank tests. RESULTS: The cumulative risk for LRR/SP was lower in women <60 years (5.9%, 95% confidence interval [CI] 5.3-6.6) who are under annual follow-up than for women 60-75 (6.3%, 95% CI 5.6-7.1) receiving biennial visits. All risks were higher than the 5-year risk of a primary tumor in the screening population (ranging from 1.4% to 1.9%). Age cutoffs <50, 50-69, and > 69 revealed better risk differentiation and would provide more risk-based schedules. Still, other factors, including systemic treatments, had an even greater impact on recurrence risks. CONCLUSION: The current consensus-based recommendations use suboptimal age cutoffs. The proposed alternative cutoffs will lead to a more balanced risk-based follow-up and thereby more efficient allocation of resources. However, more factors should be taken into account for truly individualizing follow-up based on risk for recurrence. IMPLICATIONS FOR PRACTICE: The current age-based recommendations for breast cancer follow-up after 5 years are suboptimal and do not reflect the actual risk of recurrent disease. This results in situations in which women with higher risks actually receive less follow-up than those with a lower risk of recurrence. Alternative cutoffs could be a start toward risk-based follow-up and thereby more efficient allocation of resources. However, age, or any single risk factor, is not able to capture the risk differences and therefore is not sufficient for determining follow-up. More risk factors should be taken into account for truly individualizing follow-up based on the risk for recurrence.
dc.languageEnglish
dc.publisherWILEY
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0
dc.titleEvaluating the Age-Based Recommendations for Long-Term Follow-Up in Breast Cancer
dc.typeJournal Article
dc.identifier.doi10.1634/theoncologist.2019-0973
melbourne.affiliation.departmentMelbourne School of Population and Global Health
melbourne.source.titleThe Oncologist
melbourne.source.volume25
melbourne.source.issue9
melbourne.source.pagesE1330-E1338
dc.rights.licenseCC BY-NC-ND
melbourne.elementsid1456965
melbourne.contributor.authorIJzerman, Maarten
dc.identifier.eissn1549-490X
melbourne.accessrightsOpen Access


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