Recommendations for Follow-Up Care After Treatment for Breast Cancer

After having treatment for breast cancer, it is important to follow your provider’s plan for your follow-up care. Your provider may suggest routine visits and physical exams, blood tests, and/or radiology tests like X-rays, CT scans, or MRIs.

Recommendations for breast cancer follow-up care include:

Physical Exams

• See your cancer doctor 1-4 times per year for the first five years after your diagnosis. After that, you can see them once a year.
• Don’t forget other cancer screening recommendations based on your age and history. These can include Pap and HPV testing, colorectal cancer screening, and skin checks for skin cancer screening. Talk to your primary care provider about when you need screening for other cancers.

Radiology Tests

If you have had breast-conserving surgery (lumpectomy) or a single mastectomy

• Have a mammogram each year. If you have had radiation, wait 6-12 months before starting your yearly mammograms.
• If you are at a higher risk for breast cancer in the other breast, you may need a breast MRI as well.
• Other radiology exams like CT scans or bone scans to look for cancer spread (otherwise known as metastases) are not recommended.

If you have had a double mastectomy

• You likely don’t need mammograms, even after breast reconstruction. Check your chest regularly for swelling, rash, or any changes in how it looks. Call your provider if you notice any changes.
• Other radiology exams like CT scans or bone scans to look for cancer spread (otherwise known as metastases) are not recommended.

Blood Tests

• You likely will not need any blood tests as part of your normal follow-up care.

Medications

• If you are taking tamoxifen and still have your uterus, you should be seen once a year by a gynecologist or women’s health provider for an exam. Tell your provider about any vaginal bleeding right away, as this can be a sign of uterine cancer.
• If you were treated with anthracyclines (adriamycin, liposomal doxorubicin, epirubicin, HER2-targeted therapy (Herceptin, Perjeta, Phesgo, Kadcyla, Enhertu, Tukysa, Nerlynx, Tykerb), or had radiation to your left chest, you should be screened for heart failure/cardiomyopathy within 1 year of completing treatment. You may also be referred to a cardiologist for ongoing management. 
• If you are taking an aromatase inhibitor or go into menopause due to treatment, you should have a DEXA scan to measure your bone health when you start treatment. You will then need to have these scans at other times to make sure there are no changes.
• You may also need to take extra calcium and vitamin D.
• If you are taking a bisphosphonate or denosumab for bone health should pay special attention to your dental health. You may be at risk of developing a rare side effect called osteonecrosis of the jaw (ONJ). Normally, gum tissue covers the maxilla (upper jaw bone) and mandible (lower jaw bone). With ONJ, the bone becomes exposed. Pay special attention to your dental health before, during, and after treatment with bisphosphonates. Symptoms of ONJ can include pain, swelling, or infection of the gums, loosening of the teeth, and exposed bone (often at the site of a previous tooth extraction). Learn more about dental health when taking bisphosphonates or denosumab.

Genetics

• Tell your provider about any new cancers diagnosed in your family, including the type of cancer and the person's age at diagnosis. This information can help determine if genetic counseling and testing would be helpful.

Coping and Mental Health

• It's common for survivors to experience distress, depression, anxiety, or fear of recurrence even years after treatment has ended. You don't have to manage this alone. Talk with your providers about mental health support, including counseling/therapy, support groups, and other resources. 

Healthy Living After Cancer

• Having an active lifestyle and maintaining a healthy weight, with a body mass index (BMI) of 20-25, may lower the risk of your cancer coming back and can also help address underlying risk factors for cardiotoxicity.
• Weight-bearing exercises, such as walking, yoga, and dancing, can also help keep up bone strength.
• Limit how much alcohol (beer, wine, liquor) you drink.
• Talk with your provider about resources to get started (or get back to) a healthy lifestyle, including exercise, healthy eating, and mental health support.
• Hormone replacement therapy (HRT) is not used in most breast cancer survivors to manage menopause symptoms.  If you are having a hard time with symptoms, talk to your provider about non-hormonal medications and treatments that can help.