{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:34:44Z","timestamp":1791434084757,"version":"4.3.3"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T00:00:00Z","timestamp":1638144000000},"content-version":"vor","delay-in-days":518,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>After 5\u2009years of annual follow-up following breast cancer, Dutch guidelines are age based: annual follow-up for women &amp;lt;60\u2009years, 60\u201375\u2009years biennial, and none for &amp;gt;75\u2009years. We determined how the risk of recurrence corresponds to these consensus-based recommendations and to the risk of primary breast cancer in the general screening population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects, Materials, and Methods<\/jats:title>\n                  <jats:p>Women with early-stage breast cancer in 2003\/2005 were selected from the Netherlands Cancer Registry (n =\u200918,568). Cumulative incidence functions were estimated for follow-up years 5\u201310 for locoregional recurrences (LRRs) and second primary tumors (SPs). Risks were compared with the screening population without history of breast cancer. Alternative cutoffs for age were determined by log-rank tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The cumulative risk for LRR\/SP was lower in women &amp;lt;60\u2009years (5.9%, 95% confidence interval [CI] 5.3\u20136.6) who are under annual follow-up than for women 60\u201375 (6.3%, 95% CI 5.6\u20137.1) receiving biennial visits. All risks were higher than the 5-year risk of a primary tumor in the screening population (ranging from 1.4% to 1.9%). Age cutoffs &amp;lt;50, 50\u201369, and &amp;gt;\u200969 revealed better risk differentiation and would provide more risk-based schedules. Still, other factors, including systemic treatments, had an even greater impact on recurrence risks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The current consensus-based recommendations use suboptimal age cutoffs. The proposed alternative cutoffs will lead to a more balanced risk-based follow-up and thereby more efficient allocation of resources. However, more factors should be taken into account for truly individualizing follow-up based on risk for recurrence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications for Practice<\/jats:title>\n                  <jats:p>The current age-based recommendations for breast cancer follow-up after 5\u2009years are suboptimal and do not reflect the actual risk of recurrent disease. This results in situations in which women with higher risks actually receive less follow-up than those with a lower risk of recurrence. Alternative cutoffs could be a start toward risk-based follow-up and thereby more efficient allocation of resources. However, age, or any single risk factor, is not able to capture the risk differences and therefore is not sufficient for determining follow-up. More risk factors should be taken into account for truly individualizing follow-up based on the risk for recurrence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2019-0973","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T13:25:18Z","timestamp":1591622718000},"page":"e1330-e1338","source":"Crossref","is-referenced-by-count":10,"title":["Evaluating the Age-Based Recommendations for Long-Term Follow-Up in Breast Cancer"],"prefix":"10.1093","volume":"25","author":[{"given":"Annemieke","family":"Witteveen","sequence":"first","affiliation":[{"name":"Department of Biomedical Signals and Systems \/ Personalized eHealth Technology, University of Twente, Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"de Munck","sequence":"additional","affiliation":[{"name":"Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands"},{"name":"Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catharina G.M.","family":"Groothuis-Oudshoorn","sequence":"additional","affiliation":[{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabe S.","family":"Sonke","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip M.","family":"Poortmans","sequence":"additional","affiliation":[{"name":"Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium"},{"name":"University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesbeth J.","family":"Boersma","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Maastricht University Medical Center (Maastro), Maastricht, The Netherlands"},{"name":"GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjolein L.","family":"Smidt","sequence":"additional","affiliation":[{"name":"GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands"},{"name":"Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid M.H.","family":"Vliegen","sequence":"additional","affiliation":[{"name":"Department of Industrial Engineering and Innovation Sciences, Technical University Eindhoven, Eindhoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J.","family":"IJzerman","sequence":"additional","affiliation":[{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands"},{"name":"University of Melbourne, Centre for Cancer Research and Centre for Health Policy, Parkville, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Siesling","sequence":"additional","affiliation":[{"name":"Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands"},{"name":"Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,6,29]]},"reference":[{"key":"2021122510540322900_onco13406-bib-0001","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ejon.2011.07.004","article-title":"Evaluation of the adherence to follow-up care guidelines for women with breast cancer","volume":"16","author":"Grandjean","year":"2012","journal-title":"Eur J Oncol Nurs"},{"key":"2021122510540322900_onco13406-bib-0002","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3322\/caac.21319","article-title":"American Cancer Society\/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline","volume":"66","author":"Runowicz","year":"2016","journal-title":"CA Cancer J Clin"},{"key":"2021122510540322900_onco13406-bib-0003","year":"2019"},{"key":"2021122510540322900_onco13406-bib-0004","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1001\/jama.271.20.1593","article-title":"Intensive diagnostic follow-up after treatment of primary breast cancer. 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