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Topic: No blood tests at 6 month checkup

Forum: Stage I Breast Cancer — Meet other members with a Stage I breast cancer diagnosis to share information and support.

Posted on: Feb 12, 2011 06:21PM

CrazyKitties wrote:

I saw my onco for my 6 month checkup, asked about blood tests, and was told that they create too much anxiety! I was told to see my reg. doc for blood tests, and that they don't rountinely check for markers in the blood unless I am having symptoms of mestasis. Is this right?

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Feb 12, 2011 06:44PM swimangel72 wrote:

I've had 3 different oncologists - and all of them gave me blood tests. The blood tests don't just look at tumor markers (some oncs don't believe in the numbers) but they also look at other things, such as your Vitamin D and calcium levels - your white and red blood cell counts, etc etc...........so if you're not comfortable with your onc's cavalier attitude, find a new one, and soon!

3/3/08 Right-side mastectomy with immediate muscle-sparing free tram; 3/9/08 Developed abdominal MRSA staph infection and hernia;Completed 4 months Navelbine and 1 year Herceptin; Arimidex - 3 more years! Diagnosed at age 53

Dx 2/5/2008, IDC, <1cm, Stage Ib, Grade 1, 0/7 nodes, ER+/PR+, HER2+
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Feb 12, 2011 06:51PM LRM216 wrote:

I think you need a new oncologist.  I have never heard of such a thing.  I see my onc every three months and get total blood work up - Vit D, tumor markers (which she does not feel are terribly reliable but uses them as a barometer - should they begin to rise), breast checkup and total "feel" over all my lymph node regions, etc.  She follows this regime whether or not you are triple neg or hormone positive.  I hope you truly consider changing - this is your life not the onc's. 

Life isn't about waiting for the storm to end, it's about learning to dance in the rain ... Age 62 at diagnose

Dx 2/23/2009, IDC, 1cm, Stage I, Grade 3, 0/1 nodes, ER-/PR-, HER2-Surgery 03/07/2009 Lumpectomy (Right)Chemotherapy 04/25/2009 Adriamycin, Cytoxan, Taxol, TaxotereRadiation Therapy 10/21/2009 External
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Feb 12, 2011 08:41PM doingbetter wrote:

I don't know that the oncologist is necessarily being cavalier. Many doctors do not believe in testing for tumor markers in early breast cancers, and if one is getting regular check ups and full blood work with their internist, then anything else unusual would show up and can be shared with the oncologist. I actually find it more reassuring to have my regular doctor checking for things since she is looking at the whole picture, not just the cancer. My oncologist then sees the blood test results as a second set of eyes, but does not recommend anything out of the "routine" unless a problem is suspected.

Dx 6/2010, IDC, 1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+, HER2-
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Feb 12, 2011 08:57PM Letlet wrote:

I know this is not directly related to the post but I am disappointed that my onc is not ordering any scans for me. I just finished chemo and she told me that since all my scans before I started tx were all negative, she was not going to order scans for me at this point. This is after she told me that the greatest chance of recurrence is within 2 years of tx...huh???

Dx 8/27/2010, IDC, 3cm, Stage IIIa, Grade 3, 6/23 nodes, ER-/PR+, HER2+
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Feb 13, 2011 01:11AM bevin wrote:

HI Guys, as I understand it the NCCN guidelines no longer recommend tumor marker blood tests as routine review and only on presentation of symptoms. My onco however, does run them each time I have an appoinment.  I guess they feel it is one more piece of the puzzle to potentially give them a heads up of some changes that may or may not be occurring. As I understand they only get excited /concerned if the show a pattern of increases not one month up, the next the same...

Good luck, and if you are not comfortable with their approach, remember the Onco works for you. You can request they run them and if they're hesitant, you can always find a Onco who will follow you they way you prefer.

Good luck and dont be afraid to ask for what you want.  Its your health and your money paying the bill!!

Age 45, Oncotype 11, Primary Tumor 2.1 cm, smaller satellite tumor nearby

Dx 8/8/2010, IDC, 2cm, Stage II, Grade 3, 0/5 nodes, ER+/PR+, HER2-Surgery 08/10/2010 Lumpectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Radiation Therapy 10/10/2010 External
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Feb 13, 2011 02:18AM otter wrote:

My med onco never has done any tests for tumor markers.  She checked my Vit D early on, because my DEXA scan indicated I was osteopenic even before I started on Arimidex.  (My Vit D was fine.)  She also orders a chem panel for liver and kidney function but just once a year.  I'm pretty sure she would skip that blood work if I had lab results from recent testing by my PCP.  He keeps track of those things, too, but on a different schedule.

bevin is right.  The treatment guidelines from the National Comprehensive Cancer Network do not recommend routine blood tests or tumor markers for follow-up in early stage BC.  Here's what it says in the "Discussion" part of the 2011 NCCN Guidelines (version 2.2011; http://www.nccn.org):

"Post-therapy follow-up is optimally performed by members of the treatment team and includes the performance of regular physical examinations and mammography. ... The routine performance of alkaline phosphatase and liver function tests are not included in the Guidelines.  In addition, the Panel notes no evidence to support the use of 'tumor markers' for breast cancer, and routine bone scans, CT scans, MRI scans, PET scans, or ultrasound examinations in the asymptomatic patient provide no advantage in survival or ability to palliate recurrent disease and are, therefore, not recommended."

There are other recommendations for follow-up in specific situations, like women who are at high risk of bilateral BC (BRCA 1 or 2 positive, etc.), and women who are on tamoxifen.

It looks like there is no standard way of following us once we've completed our "active" treatment.  After reading about the likelihood of false-positive test results with tumor markers and the lack of survival benefit of all that surveillance in early-stage BC, I'm okay with my onco not running those tests.  I do get quizzed about new symptoms at every recheck visit, though.  I'm certain that she would order the relevant tests if I told her I was having problems.

otter

Dx IDC, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Feb 13, 2011 02:25AM jo1955 wrote:

I think I would get a new oncologist.  I am seeing mine every 4 months and have labs done each time.  Before I was started on any hormonal therapy, he ordered a DEXA scan to get a baseline for osteo - my bones are fine..  He also does a breast exam at each visit.  He does not believe in over ordering tests such as "routine" CT scans or MRIs.  He does share my lab results with my GP so both can monitor my liver function.  I am taking a cholesterol med and liver function has to be checked on a regular basis.

Jo - Lump, no chemo, 25 rads + 5 boosts, Tamox X5 years . Three years cancer free - Aug 30th, 2013. July 13, 2013 - Hysterectomy due to multiple uterine issues while on Tamoxifen.

Dx 8/30/2010, IDC, <1cm, Stage Ia, Grade 2, 0/3 nodes, ER+/PR+, HER2-Surgery 08/30/2010 Lumpectomy (Left)Surgery 08/30/2010 Lymph Node Removal: Sentinel Lymph Node Dissection (Left)Radiation Therapy 09/21/2010 ExternalHormonal Therapy 01/03/2011 TamoxifenSurgery 04/18/2012 Reconstruction: Latissimus Dorsi flap (Left)
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Feb 13, 2011 02:59AM CrazyKitties wrote:

DAMN. Thank you ALL for your knowledge and experience. I can't believe he didn't want to check my liver function! I am going to my PA to have some tests done now.

Thank you all, really, for taking the time for me. I hope this thread helps others.

xoxoxxo

Dx 4/2010, IDC, 1cm, Stage I, Grade 1, 1/20 nodes, ER+/PR+, HER2-
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Feb 13, 2011 05:00PM otter wrote:

CrazyKitties, I need to note that the reason my PCP does blood work regularly has nothing to do with my BC diagnosis.  He has been treating me for high cholesterol, high blood pressure, and hypothyroidism, for more than 10 years.  The blood work is to monitor my TSH and cholesterol and to make sure the statin I'm on isn't messing up my liver function.

It's just coincidental that he's doing some of the same tests my med onco would do.  And, I don't think my med onco would be ordering them if I wasn't on Arimidex.  Nobody is looking specifically for mets with any of the blood work I'm getting.

otter

Dx IDC, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Feb 13, 2011 05:18PM doingbetter wrote:

I'm not sure I understand why with no known benefit to diagnosing mets "early" before one is exhibiting any symptoms, people would want to be tested, monitored and scanned so much. It's one thing if there are specific issues or concerns that are being watched, but so long as one is feeling good, living a healthy lifestyle and getting the routine recommended checkups (including whatever bloodwork), it seems to me that it would be a lot less stressful to assume you are well and just live and enjoy life. Sometimes I feel like we are looking for trouble by testing so much, and robbing ourselves of the good/healthy time that we have - however long that may be...

Dx 6/2010, IDC, 1cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+, HER2-
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Feb 14, 2011 01:50PM momand2kids wrote:

My onc does not do tumor markers--she feels that they are not accurate.... I started out after my dx and tx wanting practically daily testing..... before surgery I had a full MRI and mammo--- and a bone scan to get a baseline..... 

But,as time has gone on, I have become a fan of less is more..... I go every 6 months to the onc, once a year to the pcp and gyn and have the mri and mammo--so 6 times a year I am reviewed by someone or something.  I do find these visits a little more stressful--- but I can deal with it for 24-48 hours..... but in the in between times, I just forget about it.... I had an excellent prognosis, but who knows what the future will bring.  I figure I did everything I could to prevent a recurrence--- it is out of my hands.......

but, as we all know, everyone is different and for some people, more testing is more security....

whatever works  

Dx 10/29/2008, ILC, 2cm, Stage II, Grade 2, 0/1 nodes, ER+/PR+, HER2-Surgery 11/25/2008 Lumpectomy (Right)Chemotherapy 01/16/2009 AdriamycinRadiation Therapy 03/23/2009 ExternalHormonal Therapy 06/15/2009 Femara