Il follow-up o lo spazio delle contraddizioni. Il caso del tumore alla mammella e lo studio Futura

Objectives. The follow-up of breast cancer is still a controversial issue. Even though there is no evidence in the literature on the effectiveness of an intensive approach, there is a trend to request and prescribe more than necessary, especially in low-risk women. Currently, after primary treatment, the majority of women is followed by the hospital specialist, and there is presently no established care outside the hospital. The details of a randomized trial in which low-risk women have been randomly assigned to follow-up managed by a specialist or a general practitioner are described in order to evaluate the feasibility of follow-up with a minimalist approach. A qualitative approach to follow-up, conducted through focus groups and interviews with women and health workers, is also presented. Methods. For the qualitative approach part, an analysis of the narratives of 20 women, 10 health workers, and three discussion groups concerning key aspects of the follow-up was performed. These key points were definition of "low risk", stress control, trust in the physician, and follow-up inequalities and contradictions. Results. About one hundred women have been enrolled in the ongoing trial so far. Breast cancer follow-up remains an issue of great interest to clinicians and, especially, to women who have been operated on. These women feel constantly on the edge between "cured" and continuously "under control". Conclusions. The two different approaches, a clinical trial on follow-up, and a qualitative study involving focus groups and interviews, are needed to explore the many different aspects of follow-up, including clinical examination, the doctor-patient relationship, and the information on, and participation in, the process of care.