NICE breast cancer guideline needs a rethink

Experts call for overhaul of breast cancer follow-up checks to ensure quick detection of recurrences.

Better communication is needed between oncologists and GPs to help improve outcomes for breast cancer patients in remission, say experts.

The notification of a recurrent or second tumour must be given in a matter of days, rather than weeks.

The call comes as clinicians recommend an overhaul of NICE guidelines that cover the follow-up of women who have suffered from breast cancer.

Mr Michael Dixon, clinical director at the Edinburgh Breast Unit, and colleagues say a mammographic surveillance programme and direct access to specialist units is needed.

Existing NICE guidelines on follow-up for breast cancer in patients in England and Wales, published in 2002, were designed to detect and treat local recurrence, deal with effects of treatment and provide psychological support for women.

NICE advises frequent follow-up over the first few years.

But women with a history of breast cancer have a 1-1.5 per cent risk of developing a recurrent or new breast cancer in the first 10 years, with 70 per cent of these tumours occurring after three years.

As well as making sure con-cerned patients can get appoint-ments with oncologists quickly, specialist units must relay any outcomes to GPs quickly, said Mr Dixon.

'In the hospital we are not very good at communicating with GPs and the GPs are left in the dark,' he said.

A NICE spokesman said the guideline was already being reviewed and should be published in February 2009.

- BMJ 2008; 336: 107-8, live links at

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