Medical Care After Treatment
After you finish treatment for breast cancer, you’ll see your oncologist and other members of your health care team on a regular basis, usually about every 6 months for the first few years. After that, you’ll see them every year for many years.
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 any problems you’re having taking medications, such as hormone therapy.
- Manage side effects of treatment, such as menopausal symptoms or numbness and tingling in the fingers and toes.
- Discuss ways to help lower your risk of breast cancer recurrence, such as maintaining a healthy weight.
- Check for signs of lymphedema.
- Check for changes in your family history and refer you to genetic counseling or genetic testing, if appropriate.
- 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.
Continue to see your primary care provider and other health care providers to [3-5]:
- Monitor your general health, such as checking your blood pressure, cholesterol and risk factors for heart disease.
- Get other routine health screenings, such as bone density tests and screening for other cancers.
- Get gynecological care (for women), such as pelvic exams and Pap smears.
- Manage other medical problems.
Recommended medical care after breast cancer treatment
- Physical exams
- Bone health tests
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 doing emotionally.
If you feel anxious or depressed, tell your health care provider. They may refer you to a support group, counselor or other resources. They may also 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
Everyone treated for breast cancer
1-4 times a year (depending on your situation) for 5 years, then every year
Mammogram (of the remaining breast tissue and/or opposite breast)
People treated with lumpectomy plus radiation therapy
6-12 months after radiation therapy ends, then every year
People treated with mastectomy
1 year after mammogram that led to diagnosis, then every year
People treated with mastectomy and breast reconstruction
The reconstructed breast(s) does not need mammography screening
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 National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO) and American Cancer Society materials [3-5].
The Centers for Disease Control and Prevention (CDC) recommends breast cancer survivors get the seasonal flu shot.
If you’re currently in treatment for breast cancer or have been treated in the past, you’re at higher risk for complications from the seasonal flu .
If you’ve had chemotherapy, radiation therapy or other breast cancer treatments in the past month, call your health care provider 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
- Yellowing of the skin or whites of the eyes (jaundice)
Don’t panic if you have signs or symptoms like fatigue, weight change or bone pain. These are common problems for many people. Most often, they don’t mean the breast cancer has spread. For example, bone pain may be a sign of arthritis or muscle strain. And, many people have fatigue for a number of reasons.
However, discuss any signs or symptoms you have (especially if they last more than 2 weeks) with your health care provider to find out the cause. It’s always OK to get a second opinion, especially if you feel your health care provider isn’t listening to your concerns.
If you don’t have any symptoms that could be related to breast cancer recurrence, and if there are no concerning findings on your physical exam, you don’t need extra tests. There’s no role for lab tests, X-rays, CT scans, bone scans or PET scans if you’re not having any symptoms and there are no findings on your physical exam.
If you have signs and symptoms that might be due to breast cancer recurrence, your health care team will order follow-up tests to see if the breast cancer has returned and spread to other organs (metastasized).
Depending on your signs and 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 signs or symptoms of metastases, using blood or imaging tests (other than mammography) does not increase survival [4,7]. These tests are not a standard part of follow-up care.
Learn about the risk of breast cancer recurrence.
Learn about treatment for local breast cancer recurrence.
Learn about metastatic breast cancer.