What laboratory tests are recommended after breast cancer eradication?

From the Guidelines

After breast cancer eradication, no routine laboratory tests are recommended for surveillance, except for patients on hormone therapy who require monitoring for potential side effects. The most recent and highest quality study, 1, published in 2015, states that in asymptomatic patients, there are no data to indicate that other laboratory or imaging tests produce a survival benefit. However, the study recommends regular visits every 3–4 months in the first 2 years, every 6 months from years 3–5, and annually thereafter, which should include thorough history taking, eliciting of symptoms, and physical examination. Additionally, the study suggests that routine blood tests are usually indicated to follow-up patients on endocrine therapy (ET) due to the potential side-effects of these drugs, namely in the lipid profile. Some key points to consider include:

• Annual ipsilateral and/or contralateral mammography with ultrasound is recommended.
• Ultrasound can be considered in the follow-up of lobular invasive carcinomas.
• For patients on tamoxifen, an annual gynaecological examination, possibly with a gynaecological ultrasound, by an experienced gynaecologist is recommended.
• Regular bone density evaluation is recommended for patients on aromatase inhibitors.
• Genetic testing may be recommended for patients with strong family histories or early-onset disease. It's essential to individualize the testing regimen based on cancer type, stage, treatments received, and personal risk factors, with all monitoring conducted under oncologist supervision, as stated in 1 and 1. The use of tumor markers such as CA 15-3, CA 27.29, or CEA is not recommended for routine surveillance, as stated in 1 and 1, due to limited sensitivity and specificity. Overall, the focus should be on individualized monitoring and follow-up care, rather than routine laboratory testing, to ensure the best possible outcomes for patients after breast cancer eradication.

From the Research

Laboratory Tests After Breast Cancer Eradication

The following laboratory tests are recommended after breast cancer eradication:

• Annual mammography 2
• Assessment of hormone receptors (estrogen and progesterone) to direct therapy for women with breast cancer 3, 4
• Surveillance of patients with diagnosed breast cancer using markers such as CA 15-3 and BR 27.29, although the benefit of this monitoring on patient outcome or quality of life is not clear 3, 5
• Monitoring for long-term sequelae of treatment, which is becoming as important as the detection of recurrence in an era where long-term survival is increasingly common 2

Biochemical Markers

Biochemical markers that are clinically useful in breast cancer include:

• Estrogen and progesterone receptors to predict response to hormone therapy 3, 4
• CA 15-3 and BR 27.29 for surveillance of patients with diagnosed breast cancer 3, 5
• c-erbB-2 for predicting response to the therapeutic antibody, Herceptin 3, 5

Follow-up Care

Follow-up care after breast cancer eradication should include:

• Regular clinical assessment 2
• Annual mammography 2
• Breast imaging, which plays a major role in the early detection of second primary breast cancers and loco regional recurrences 6
• Minimizing physical examination to detect relapses early, as its yield is low 6