Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

Procedural and declarative knowledge: an evolutionary perspective

It appears that there are resemblances in the organization of memory and the visual system, although the functions of these faculties differ considerably. In this article, the principles behind this organization are discussed. One important principle regards the distinction between declarative and procedural knowledge, between knowing that and knowing how. Declarative knowledge is considered here not as an alternative kind of knowledge, as is usually the case in theories of memory, but as part of procedural knowledge. In our view this leads to another approach with respect to the distinction. Declarative knowledge has occupied more attention in (cognitive) psychological research than can be justified on the basis of the importance of procedural knowledge for behavior. We also discuss the question whether there are other brain faculties that reflect the same organizational characteristics. We conclude with some speculations about the consequent role of consciousness in such a tentative model