Follow-up after treatment for breast cancer
Breast cancer behaves differently in each woman, and a standard follow-up schedule would not work for everyone. Women with breast cancer should talk to their doctor about a follow-up plan that suits their individual situation. Follow-up care is often shared among the surgeon, cancer specialists (oncologists) and the family doctor.
After treatment has ended, new symptoms and symptoms that don’t go away should be reported to the doctor without waiting for the next scheduled appointment. These may include:
- pain, especially in the legs, back or hips
- persistent cough or difficulty breathing
- a lump in either breast, the neck, underarms or groin
- unusual changes (such as thickening or lumps) at the site of the surgery or within the scar itself
- unexplained or increasing fatigue
- loss of appetite or unexplained weight loss
- tingling or numbness in the arm or hand
- swelling in the hand or arm
- persistent headache or new neurological symptoms, such as double vision, numbness or weakness in the arms or legs or any other unusual or severe symptoms
- vaginal spotting or bleeding – for women who still have their uterus and are taking tamoxifen (Nolvadex)
The chance of breast cancer recurring is greatest within 5 years, so close follow-up is needed during this time. Women who have been diagnosed with breast cancer are also at an increased risk of developing cancer in the opposite breast, as well as cancers of the colon, ovary and uterus.
Follow-up after breast cancer treatment varies. Follow-up visits are usually scheduled:
- every 3–6 months for the first 3 years after treatment
- every 6–12 months for the next 2 years
- then once a year
During a follow-up visit, the doctor usually asks questions about the side effects of treatment, how the woman is coping and any new symptoms. The doctor may do a complete physical examination, including:
- clinical breast exam (CBE)
- This exam includes checking the lymph nodes in the armpit, neck and collarbone areas.
- The doctor will also examine the chest wall and the surgical scar.
- pelvic examination, including a Pap test
- checking the lungs and abdomen
- looking for signs of swelling in the hand and arm (lymphedema)
The only test that is done regularly as part of follow-up for breast cancer is mammography. It is done on both breasts (if the woman had breast-conserving surgery) or on the remaining breast (if the woman had a mastectomy). Mammography is scheduled:
- 6 months after treatment for breast cancer is finished
- then once a year
Routine tests, other than a mammogram, are not recommended if a woman does not have any symptoms. Tests may be ordered if there are symptoms or if the doctor suspects the cancer has come back (has recurred).
- blood chemistry tests
- The doctor may order blood chemistry tests to see if the breast cancer has spread to the liver or bones.
- bone scan
- A bone scan may be done to check for cancer that has spread to the bones.
- other imaging tests
If a recurrence is found during follow-up, the oncology team will assess the person with cancer to determine the best treatment options.
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