Review Article

Metastatic screening for patients with newly diagnosed breast cancer: Who and how?

Jenny Edge, Melissa Budge, Adiel Webner, Alexander Doruyter, Glen Cilliers, Francois Malherbe
South African Journal of Oncology | Vol 4 | a94 | DOI: https://doi.org/10.4102/sajo.v4i0.94 | © 2020 Jenny Edge, Melissa Budge, Adiel Webner, Alexander Doruyter, Glen Cilliers, Francois Malherbe | This work is licensed under CC Attribution 4.0
Submitted: 23 July 2019 | Published: 06 April 2020

About the author(s)

Jenny Edge, Division of Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Melissa Budge, Division of Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Adiel Webner, Division of Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Alexander Doruyter, Division of Nuclear Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Glen Cilliers, Morton and Partners Radiologists, Cape Town, South Africa
Francois Malherbe, Division of Surgery, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa


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Abstract

Background: Staging for breast cancer patients, as defined by the American Joint Committee on Cancer (AJCC), has historically been limited to anatomical staging. However, the eighth version of the AJCC guidelines has been altered to include tumour biology. Anatomical staging still has a place especially in low-middle income countries where the majority of patients present with locally advanced or metastatic disease.

Aim: This review article considers which newly diagnosed breast cancer patients should be referred for anatomical staging and the pros and cons of the different modalities available in South Africa.

Method: The different modalities available were reviewed with respect to metastatic screening for asymptomatic women. The usefulness of the modalities were considered with reference to organ-specific disease rather than the stage of the patient.

Results: Any person with newly diagnosed breast cancer and symptoms suggestive of systemic involvement should be investigated. All symptomatic women who present with a tumour larger than 5 cm, radiological or clinical evidence of nodal disease, triple negative or HER2+ve tumours should have metastatic screening. This gives information about the primary as well as the metastatic status.

Conclusion: However, increasingly, the major determinant of treatment is the biology of the cancer and not the anatomical stage. In future, this trend is likely to increase with anatomical staging becoming less important.


Keywords

breast cancer; metastatic disease; screening; guidelines; best practice; review

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