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Monitoring may be more tailor-made depending on the risk of relapse, so that low-risk women need to go to the hospital less frequently for a mammogram. Personalized tracking prevents unnecessary burden on both the patient, carers and the health care budget. For example, high-risk patients could receive more controls if necessary. Patients with lower risk, after proper consultation between the doctor and the patient, will need fewer follow-up visits.
Treatments are getting better
In the Netherlands almost 50 women are told daily they have breast cancer and this number is increasing. On the contrary, the number of women who die from breast cancer is decreasing. This is due to the fact that therapies are improving and because they are discovered earlier. After breast cancer treatment, women are at risk of developing the disease. This is called repetition. Within 10 years after treatment, about 4% of women will experience reappearance in the same breast and about 5% will develop new tumor in the other breast. The purpose of monitoring is to find relapses as early as possible because the results for the patient are better.
Difference in return risk
Although there is more and more personalization (personalized) in the treatment of breast cancer, this is not the case with monitoring: it is still based on consensus and does not adapt to the actual risk a patient has. Witteveen: "At this time breast cancer monitoring is the same for everyone in the first five years, an annual mammogram and physical examination." After five years, monitoring according to the current guideline depends on the age of the patient But there is a difference in the risk of return of breast cancer per patient, so it would be more reasonable for women at low risk to be checked less frequently and women at high risk can be controlled for more than five years.
Intensity and uncertainty
The study showed that women with higher risk were even less monitored than women at lower risk. At present, about half of the relapses are also detected by the woman itself and not during the follow-up. And although monitoring can also be reassured, mammography is unpleasant and subsequent controls also provide tension and uncertainty. So when women have a very low risk, they are really unnecessary burdens. In addition, healthcare providers are also charged and there are costs related to the follow-up, also for the patient. Mirjam Velting, director of the Breast Cancer Federation program in the Netherlands: "Monitoring visits are not always necessary from a medical point of view, this is virtually never discussed with the patient, and this is also a time of choice in a conversation between the provider care and patient ".
Manage the tracking control
This is why it is important to optimize monitoring based on personal risk of recurrence. The Dutch Cancer Registry (NKR) was used to determine the risk of recurrence. Almost all new cases of cancer have been registered since 1989 in the NKR. The data set used for the study included about 50,000 women. Together with the Dutch Integrated Cancer Center (IKNL) and health care providers, Witteveen has developed the INFLUENCE Law, which identifies the risk of repetition.
In her research, Witteveen also shows that breast cancer monitoring can be optimized based on the risk of recurrence for any possible risk profile, taking into account the benefits of early detection and the drawbacks of monitoring such as discomfort and tension. With this model, doctors can make informed decisions along with the patient. For example, high-risk women could receive more controls if necessary, and patients at lower risk would be relieved of unnecessary follow-up visits.
Professor Dr. Siesling, one of Witteveen's supporters: Together with care providers, united in NABON, nurses, general practitioners and the Breast Cancer Association, we look at how this model to develop and develop better in everyday practice. And from the calculations, presenting the risk in a meaningful way, but also by the organization, at what time and with whom you are discussing the risk. Additionally, monitoring is just an element of individual care, which also includes psychosocial complaints, for example. »