Recommendations for Follow-Up Care After Treatment for Breast Cancer
After treatment for breast cancer, it is important for you to adhere to your provider’s plan for follow-up care. This article reviews the most common follow-up recommendations. You should talk with your care team about your specific follow-up plan.
Screening for recurrence or new cancers
- You should be seen by your oncology team 1-4 times per year for 5 years, and then annually after 5 years. Your provider will determine your follow-up appointment schedule with you.
- Survivors who have had breast-conserving surgery (lumpectomy) or a single mastectomy should have a mammogram annually. In addition, breast MRI may be considered for survivors at high risk for cancer in the other breast. If you have had breast-conserving surgery (lumpectomy) and radiation, you should wait 6-12 months after radiation before beginning annual mammograms.
- Those who have had double mastectomy generally do not need mammograms. You should examine your chest wall for swelling or rash and report any changes to your provider.
- It is important to remember that you should follow 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.
If you are taking hormone therapy
- If you are taking tamoxifen and still have your uterus, you should see a gynecologist or women’s health provider every year for an exam. Report any vaginal bleeding to your provider immediately, as this can be a sign of uterine cancer.
- If you are taking an aromatase inhibitor or go into menopause due to treatment, you should have a baseline bone health evaluation by a Dexa scan and then periodically thereafter as both of these can lead to loss of bone strength.
What about radiology and lab tests?
Routine lab testing, CT scans or bone scans to look for cancer spread (otherwise known as metastases) are not recommended. Research has shown that if a woman does develop metastatic disease, the type of treatment, response to treatment, and overall survival are equivalent, regardless of if it is found before symptoms develop. In other words, outcomes are similar for those who are treated for metastases found on routine scans (with no symptoms present) and women who are not treated until those metastases cause symptoms. Therefore, providers do not routinely screen patients for metastatic disease unless they have developed symptoms.
Healthy living after cancer
- Research has shown that leading an active lifestyle and maintaining a healthy weight, with a BMI (body mass index) of 20-25, may lower the risk of recurrence.
- Getting regular exercise and eating a healthy diet can help you reach this goal.
- Weight-bearing exercises, such as walking, yoga, and dancing can also be helpful in keeping your bones strong.
- Talk with your healthcare team about how to get started with (or back to) an exercise regimen!
- It is also important to maintain your health insurance so that you can continue to receive your follow-up care as recommended. If you are having insurance issues, ask your team for a referral to a social worker who can assist with this.
- Be sure to report any new or unusual symptoms to your healthcare team.
If you are taking a bisphosphonate or denosumab
Survivors who are taking a bisphosphonate or denosumab for bone health should pay special attention to their dental health. You may be at risk of developing a rare side effect called osteonecrosis of the jaw (ONJ). Normally, the maxilla (upper jaw bone) and mandible (lower jaw bone) are covered by gum tissue. In the case of ONJ, the bone becomes exposed. It is important to 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.