Authors' objectives:

This report looks at surgery, radiotherapy, hormone therapy, chemotherapy drugs to prevent or reduce nausea and vomiting after chemotherapy, follow-up after surgery and adjuvant treatment, and breast cancer nurses.

Authors' recommendations: 1. Surgery - the choice between mastectomy and breast conservation depends on tumour factors and patient preference; cost is not a factor in that choice. 2. Radiotherapy is effective and cost-effective in reducing local recurrence after surgery. 3. Hormone treatment with tamoxifen is effective and highly cost-effective. Should other hormone therapy be required we recommend progesterone treatment. 4. Adjuvant chemotherapy with CMF after surgery is effective in reducing recurrences and improving long-term survival. 5. Metastatic disease is at present incurable. There are useful treatments to slow progression and relieve symptoms, including inexpensive radiotherapy and expensive bisphosphonates. Standard chemotherapy such as CMF or anthracyclines may fail, but newer treatments such as the taxane drugs should be restricted to randomised trials. 6. The newer anti-emetics such as ondansetron are more effective in the first 24 hours of chemotherapy than older agents, but are much more expensive. 7. There is a shortage of good research and therefore of evidence regarding breast cancer nurses, but they provide valuable information, advice and support. 8. Traditional follow-up frequency is more intensive than is justified. However, we support the SIGN recommendations on collection of data for audit, evaluation and research, which might best be achieved by retaining some hospital follow-up. The optimum frequency of follow-up mammography is uncertain; we recommend 2-yearly rather than yearly. 9. Breast cancer care and outcomes have improved through the application of existing knowledge, but metastatic disease is at present incurable and more research is needed there.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.nhsconfed.net/shpic/doc14.htm

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

Organisation Name: Scottish Health Purchasing Information Centre

Copyright: Scottish Health Purchasing Information Centre