After Breast Cancer
What You Need to Know about Follow-Up Care
After completing treatment for breast cancer, follow-up care is important to help maintain good health, which includes managing any side effects from treatment and watching for long-term side effects (called late effects) or signs of a cancer recurrence.
A follow-up care plan for breast cancer survivors may include regular physical examinations, mammograms, breast self-examinations, and other medical tests to monitor your recovery for the coming months and years. About a year after diagnosis, you may continue to visit your oncologist, or you may transfer your care to a primary care doctor, as long as your primary care doctor has talked with your oncologist about appropriate follow-up care and the possible late effects of cancer treatment. Women receiving hormonal therapy should talk with their oncologist about how often to schedule follow-up visits for re-evaluation of their treatment. Use these American Society of Clinical Oncology guideline recommendations to talk with your doctor about an appropriate follow-up care plan for you.
Medical History and Physical
Visit your doctor every three to six months for the first three years after the first treatment, every six to twelve months for years four and five, and every year thereafter.
Schedule a mammogram one year after the first mammogram that led to your diagnosis. However, if you have had radiation therapy, wait six months after your last treatment. Obtain a mammogram every six to twelve months thereafter.
Perform a breast self-examination every month. However, keep in mind that this procedure is not a substitute for a mammogram.
Continue to visit a gynecologist regularly. Because the drug tamoxifen (Nolvadex) increases the risk of uterine cancer, women taking this drug should tell their doctors about any abnormal vaginal bleeding.
Another important part of follow-up care is to tell your doctor if you have a history of cancer in your family, because you may benefit from genetic counseling. The following risk factors may indicate that breast cancer could run in your family:
- Ashkenazi Jewish heritage
- Personal or family history of ovarian cancer
- Any first-degree relative (mother, sister, daughter) diagnosed with breast cancer before age 50
- Two or more first-degree or second-degree relatives (grandparent, aunt, uncle) diagnosed with breast cancer
- Personal or family history of breast cancer in both breasts
- History of breast cancer in a male relative
The following tests are not currently recommended by ASCO for regular follow-up care because they have not been shown to lengthen the life of a person with breast cancer:
- A complete blood count (CBC) test, and liver and kidney function tests
- Chest X-ray
- Bone scan
- Liver ultrasound
- Computed tomography (CT or CAT) scan
- Fluorodeoxyglucose-positron-emission tomography (FDG-PET) scan
- Breast magnetic resonance imaging (MRI) test
- Breast cancer tumor markers, such as CA 15-3, CA 27.29, and carcinoembryonic antigen (CEA)
Signs of Recurrence
Many survivors feel worried or anxious that the cancer will come back after treatment. While it often does not, it’s important to talk with your doctor about the possibility of the cancer returning. Most breast cancer recurrences are found by survivors between doctor visits. Tell your doctor if you notice any of the following symptoms, as they may be signs of a cancer recurrence:
- New lumps in the breast
- Bone pain
- Chest pain
- Abdominal pain
- Shortness of breath or difficulty breathing
- Persistent headaches
- Persistent coughing
- Rash on breast
- Nipple discharge
Questions to Ask Your Doctor
To learn more about follow-up care for breast cancer, consider asking your doctor the following questions:
♦ What follow-up care plan would you recommend for me?
♦ What is the chance that the cancer will recur?
♦ What tests do you recommend? Why?
♦ Based on my personal and family medical history, do I need to visit a genetic counselor?
♦ Where can I find more information about follow-up care?
♦ How often should I schedule additional follow-up visits with the oncologist?
If you’re receiving hormone therapy,
also ask these questions:
♦ Are there any signs or symptoms I should watch for?
♦ What side effects are common with this treatment?
♦ ♦ ♦ ♦ ♦
Reprinted with permission from Cancer.Net. © 2013 American Society of Clinical Oncology. All rights reserved.
This article was published in Coping® with Cancer magazine, September/October 2013.