Medical Care After Treatment
Breast cancer survivors should see their health care providers on a regular basis.
The goals of follow-up visits are to:
- Find breast cancer that has returned to the breast, chest or nearby lymph nodes (local recurrence).
- Find breast cancer that has returned and spread to other parts of the body (metastasis).
- Manage problems you are having taking medications (such as hormone therapy).
- Manage side effects of treatment (such as menopausal symptoms).
- Discuss ways to help lower your risk of breast cancer recurrence (such as maintaining a healthy weight).
- Monitor for signs of lymphedema.
- Check for changes in your family history and refer you to genetic counseling if appropriate.
- Provide other routine health screenings (such as screening for colon and skin cancers, bone density tests and for women, pelvic exams and Pap smears).
- Provide ongoing primary care (monitoring your general health, such as checking your blood pressure, cholesterol and risk factors for heart disease) and manage any other medical problems.
- Provide medical updates that might change your follow-up care.
- Provide resources, information and sometimes medications to manage worries, anxiety, distress or depression.
- Provide emotional support.
- Give you a time to ask questions and share concerns.
Recommended medical care after treatment
- Physical exams
- Bone health tests
- Pelvic exams (for women)
During follow-up visits, your health care provider will ask you about any symptoms or concerns you may have.
These visits are a good time to discuss how you’re coping emotionally.
If you feel anxious or depressed, tell your provider. Your provider may refer you to a support group, counselor or other resources. Sometimes he or she may recommend medication to treat your anxiety or depression.
Figure 6.1: Recommended medical care after breast cancer treatment
Plan for care
Medical history and physical exam
1-4 times a year (depending on your situation) for 5 years, then every year
Mammogram (for remaining breast tissue and/or opposite breast)
Women treated with lumpectomy plus radiation therapy
6-12 months after radiation therapy ends, then every year
Women treated with mastectomy
1 year after mammogram that led to diagnosis, then every year
Pap smear (Pap test)
Women ages 21-29 who have not had their uterus removed (have not had a hysterectomy)
Every 3 years
Women ages 30-65 who have not had their uterus removed (have not had a hysterectomy)
If also getting an HPV test, every 5 years (preferred)
If Pap smear alone, every 3 years
Women ages 66 and older who have not had their uterus removed (have not had a hysterectomy)
Talk with your health care provider about whether to continue Pap smears
Bone health exams
Women at higher risk of osteoporosis due to risk factors including:
Bone mineral density tests every 1-2 years, depending on a person’s risk factors
Adapted from the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), the American Cancer Society and the American Congress of Obstetricians and Gynecologists materials [3-7].
The Centers for Disease Control and Prevention (CDC) recommends breast cancer survivors get the seasonal flu shot.
People currently undergoing treatment for breast cancer and long-term survivors :
- are at higher risk for complications from the seasonal flu
- should get the seasonal flu shot
If you have had chemotherapy, radiation therapy or other breast cancer treatments in the past month, call your health care provider right away if you have any flu symptoms.
How is metastasis found?
Metastasis (distant recurrence) is most often found when people report symptoms.
These may include:
- Shortness of breath
- Weight loss
- Bone pain
Don’t panic if you have symptoms like weight change or bone pain. These are common and most often don’t mean the breast cancer has spread. For example, some women have arthritis and this pain is not related to breast cancer.
However, you should discuss any new or concerning symptoms with your health care provider.
Based on your symptoms, tests may be done to see if the breast cancer has returned and spread to other organs (metastasized).
Depending on the symptoms, follow-up tests may include:
- Blood tests (including tumor marker tests)
- Imaging tests (such as bone scans, CT scans, PET scans and chest X-rays)
- A tissue biopsy (to check if a suspicious finding is a recurrence of breast cancer)
Other tests may also be done.
For people with no symptoms of metastases, blood and imaging tests (other than mammography) are not a standard part of follow-up care.
Using blood or imaging tests to check for early metastases in people with no symptoms of metastases does not increase survival [3,9-10].
Learn about the risk of breast cancer recurrence.
Learn about treatment for local breast cancer recurrence.
Learn about metastatic breast cancer.