Follow-up after treatment for breast cancer
Follow-up after treatment is an important part of cancer care. Follow-up for breast cancer is often shared among the cancer specialists (oncologists and surgeon) and your family doctor. Your healthcare team will work with you to decide on follow-up care to meet your needs.
Don’t wait until your next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell your healthcare team if you have:
- new or worse pain, especially in your legs, hip or back
- a cough that won’t go away
- unexplained weight loss
- fatigue that gets worse over time
- swelling (called lymphedema) in your hand or arm on the same side of the body as the tumour
- headaches that won’t go away
- numbness or tingling in your hands or feet
- vaginal spotting or bleeding
- shortness of breath
The chance that breast cancer will come back (recur) is greatest within 5 years, so close follow-up is needed during this time. Women who are diagnosed with breast cancer also have a higher risk of developing cancer in the opposite breast, as well as cancer of the colon, ovary and uterus.
Schedule for follow-up visits @(Model.HeadingTag)>
Follow-up visits for breast cancer are usually scheduled:
- every 3 to 6 months for the first 5 years
- once a year after 5 years
During follow-up visits @(Model.HeadingTag)>
During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping.
Your doctor may do a physical exam, including:
- doing a clinical breast exam
- checking the surgical area to see how well it healed
- checking the scar to look for signs of a recurrence
- feeling the lymph nodes under the arm, in the neck and around the collarbone
- looking for any swelling in the hand and arm on the same side of your body as the surgery
- checking your lungs
- feeling your abdomen for any swelling or fluid
The only test that is done as a regular part of follow-up care is mammography. It is done on both breasts (if you had breast-conserving surgery) or on your remaining breast (if you had a mastectomy). Mammography is scheduled:
- 6 months after treatment for breast cancer is finished
- then once a year
Heart function tests may be also done because some drugs used to treat breast cancer can cause heart damage.
There is a chance that your bones will become fragile and thin (called osteoporosis) if you take an aromatase inhibitor. You may have a bone density scan when you start an aromatase inhibitor and on a regular basis while you take this drug.
If you are taking tamoxifen (Nolvadex, Tamofen), there is a very small chance that you could develop cancer in the lining of your uterus. Your doctor will do a pelvic exam every year to check for any changes to your uterus.
No other tests are done if you do not have any signs or symptoms that your breast cancer has recurred. Your doctor may order tests if there are symptoms of breast cancer recurrence:
- blood chemistry tests may be done to see if the cancer has spread to the liver or lungs
- bone scan may be done to see if the cancer has spread to the bones
- chest x-ray
- abdominal ultrasound
- CT scan
If the cancer has come back, you and your healthcare team will discuss a plan for your treatment and care.
American Cancer Society. Breast Cancer. 2015: http://www.cancer.org/cancer/breastcancer/index.
BC Cancer Agency. Cancer Management Guidelines Breast Cancer: Follow-up. 2013: http://www.bccancer.bc.ca/health-professionals/professional-resources/cancer-management-guidelines/breast/breast#Follow-up.
Morrow M, Burstein HJ, and Harris JR . Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 79: 1117-1156.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer (Version 2.2015). http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.