National randomised controlled trial is needed

doi:10.1136/bmj.39500.469664.1F

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Peter K Donnelly, consultant surgeon,
Louise Hiller, senior research fellow in medical statistics,
Janet A Dunn, head of cancer trials

¹South Devon Healthcare NHS Foundation Trust, Torquay TQ2 7AA
²Warwick Medical School Clinical Trials Unit, University of Warwick, Coventry CV4 7AL

peter.donnelly{at}nhs.net

Dixon and Montgomery recommend that breast cancer follow-up be evidence based, flexible, and tailored to patients’ needs.1 Unfortunately neither their proposal to provide only annual clinical review for two years nor the 2002 guideline from the National Institute for Health and Clinical Excellence, which recommends hospital based follow-up for no longer than three years for asymptomatic patients, is evidence based. A recent Cochrane review showed a wide range of recommendations for follow-up practice and identified the urgent need for a large randomised controlled trial …