Guidelines, guidelines and more guidelines: And we still do not know how to follow-up patients with breast cancer

BACKGROUND: A major challenge facing us is the provision of health care and appropriate allocation of available resources for the treatment of patients with breast cancer. This is of particular concern in the provision of follow-up care. With the increasing incidence of breast cancer and the improvements in survival which have resulted in up to 75% of patients surviving for more than five years, an increasing resource is required. However, there is controversy as to the most appropriate schedule for follow-up of these patients. This brief review has focused on the evidence-base and guidelines that currently exist in the United Kingdom for the follow-up of patients who have been treated for breast cancer. METHODS: A review of the current guidelines published in the United Kingdom for the follow-up of patients with breast cancer (National Institute for Clinical Excellence, Scottish Intercollegiate Guidelines Network, British Association of Surgical Oncology) and the randomised controlled trials evaluating the follow-up of patients with breast cancer was undertaken. RESULTS: The results have demonstrated the different follow-up protocols currently indicated in these guidelines within the same country. Furthermore, the lack of well designed, randomised controlled trials on which to base a follow-up protocol for patients with breast cancer is apparent. CONCLUSION: The evidence-base on which these guidelines have been developed is lacking. It is apparent that well designed randomised controlled trials are needed urgently if we are to understand the most appropriate and effective ways of following up patients with breast cancer.