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  • "Long-term follow-up of early-stage breast cancer patients treated by breast-conserving surgery should be based on mammography"  - David Montgomery, University Department of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK

    "The recommendations for follow up after breast cancer are inconsistent from country to country, largely as a result of inadequate evidence on which to base recommendations. Our data highlight a number of important issues.  Among 1312 women treated with breast conserving surgery for early stage breast cancer and followed for a median of ten years, potentially treatable relapse after occured at a constant rate of 1 - 1.5% for at least ten years with no early peak in incidence.  If routine follow up is to be provided after breast cancer, then it must continue for at least ten years in some form. However, clinical examination detected only 13% of potentially treatable relapses, as compared with 51% mammographically and 35% patient detected.  Moreover, ipsilateral breast relapse detected by clinical examination is associated with a significantly poorer survival than such relapse detected by mammography or patient self-examination.  It may be then that routine clinical examination is unnecessary. In contrast, mammography is of central importance to the detection of treatable relapse.  The yield when undertaken annually is 5.37 relapses detected for every 1000 mammograms performed, at least equivalent to the yield seen under a three yearly protocol in the general screening population in the UK.  This justifies the use of annual mammography in this patient population.  Given the rising incidence of new contralateral cancers seen after ten years in several studies, there may be justification for continuing to provide annual mammography indefinitely. As routine clinic visits are poor at addressing the other aims of follow up, it may be more appropriate to ensure that a good educational and self  awareness programme is in place with easy access to specialist care for patients with problems.  Ideally, a remote screening tool to assess psychological well being and adverse effects of treatment would be introduced which would allow those who have problems to be detected and brought back to clinic.  Much less frequent clinic visits could be planned to coincide with changes in adjuvant hormone therapy.  This more focussed approach would benefit the patient and be more cost effective".
    (Comment on paper:
    Montgomery DA et al.: "Changing pattern of the detection of locoregional relapse in breast cancer: the Edinburgh experience", Br J Cancer. 2007 Jun 18;96(12):1802-7)

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"Can cancer cells from donors with a yet undetected cancer be transferred to the transfusion recipient and then develop into a clinical cancer? Case reports of transmission of cancer by needle-stick injury or surgical instruments, and the emerging awareness that viable lineages of donor cells may survive long term and proliferate in the recipient (michrochimerism), make this question relevant. Although individuals with a history of cancer are normally deferred as donors, transfusion with blood from donors with an undiagnosed incipient cancer is not uncommon. Our investigation provides no evidence that blood transfusions from precancerous blood donors are associated with increased risk of cancer among the recipients. The results indicate that there is no need for considering screening for malignant disease among blood donors. This removes yet another uncertainty regarding possible long-term risks after blood transfusions
(Comment on paper:  Edgren G et al.;"Risk of cancer after blood transfusion from donors with subclinical cancer: a retrospective cohort study", Lancet. 2007, 19; 369 (9574): 1724-30)

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