Monitoring
Disease progression is
characterized by ≥1 of the following factors: Worsening symptoms, worsening
signs or new disease on physical examination, declining performance status,
unexplained weight loss, increased alkaline phosphatase, aspartate transaminase
(AST), alanine transaminase (ALT), bilirubin or serum calcium level, new
lesions on imaging exams, increased lesion size on imaging, increasing tumor
markers (eg carcinoembryonic antigen, CA 15-3, CA 27.29).
History taking and
physical examination, performance status assessment, weight measurement, liver
function tests (LFT) and CBC should be done every 1-3 months for patients given
endocrine therapy and to be done before the start of each chemotherapy cycle.
A follow-up CT scan of
the chest, abdomen or pelvis is recommended every 2-6 months for patients given
endocrine therapy and every 2-4 cycles for patients undergoing chemotherapy. Bone
scan every 4-6 cycles is recommended for patients undergoing chemotherapy and
every 2-6 months for patients given endocrine therapy. Repeat PET/CT scan and tumor
markers may be obtained as clinically indicated. Lastly, MRI is
recommended for individuals with a personal history of breast cancer diagnosis
at age ≤50 or in those with dense breasts.