The Who, What, Where, When and Sometimes, Why.

Medical Care After Treatment

Important information about coronavirus (COVID-19).

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

Follow-up care after breast cancer treatment (see Figure 6.1) includes [3-4]:

  • Physical exams
  • Mammograms
  • 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.

Learn more about support groups and other types of support.

Figure 6.1: Recommended medical care after breast cancer treatment

 

Who

Plan for care

Medical history and physical exam

All survivors

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

Pelvic exam

All survivors

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:

  • Aromatase inhibitor use
  • Early menopause due to treatment
  • Age 65 years or older
  • Age 60-64 years with family history of osteoporosis or with low body weight

 

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 [8]:

  • 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.

Find more information from the CDC about the seasonal flu.  

 

  • What does my follow-up care include? What is the schedule of my follow-up visits?
  • Which health care provider is in charge of my follow-up care? Which providers will I continue to see? Is there anyone I don’t need to see anymore?
  • What symptoms should I be aware of and discuss with you (or the provider in charge of my follow-up care)?
  • Are there healthy behaviors that may lower my risk of breast cancer recurrence?
  • What do I need to consider if I would like to have a child now that I’ve been treated for breast cancer?
  • What is the best way for me to treat menopausal symptoms, such as hot flashes? What can I do to manage vaginal dryness and/or painful intercourse?
  • Can you suggest ways my spouse/partner and I can address issues related to our post-treatment sexual relationship or refer me to a psychologist or counselor who specializes in these issues?
  • Tell me about lymphedema and my chances for developing it. What signs or symptoms should I watch for and tell you about?
  • Can you suggest a counselor or support group that can help me adjust to life after breast cancer treatment?
  • How does my having breast cancer affect the risk of my family members?
  • What lifestyle behaviors can help my family members lower their risk of breast cancer?
  • Should my family or I consider being tested for BRCA1, BRCA2 or other gene mutations? Can you recommend a genetic counselor to help me and my family decide if genetic testing is right for us?
  • What issues should my family and I think about when considering genetic testing?

Learn more about talking with your health care provider

Talking with your health care provider

Lymphedema

If you have questions or concerns about lymphedema, it may be helpful to download and print Susan G. Komen®‘s Questions to Ask Your Doctor card on lymphedema. You can take it with you to your next doctor appointment. There’s plenty of space to write down the answers to these questions, which you can refer to later.

Other topics

You can also download other Questions to Ask Your Doctor cards on many different breast cancer topics.  

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.

Follow-up tests

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.

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