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Follow-Up Care After Breast Cancer Treatment
You will breathe a sigh of relief once your breast cancer treatment has been completed. But the end of treatment does not mean the end of care related to your cancer. Breast cancer survivors should understand that it is essential to have routine follow-up visits, first with their oncologist (for several years after diagnosis) and then with their primary care physician for long term follow-up and screening.
Routine follow-up after cancer treatment, known as surveillance or recurrence monitoring, allows physicians to monitor survivors closely for signs of recurrence. This monitoring is important because, as with primary cancer, early detection is key to enhancing the likelihood of successful treatment. Routine visits also provide the opportunity for your doctor to ask you questions about persistent symptoms you may have, especially those that may be related to late effects of treatment or to recurrence; to promote lifestyle habits that will enhance your well-being (such as proper diet, regular exercise, and calcium and vitamin D for good bone health); and to ensure that you are taking recommended medications (such as hormone therapy) as appropriate.
Guidelines developed by the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) include recommendations for breast cancer surveillance (Table 1). These recommendations are for women who have completed treatment and are considered to be disease free. Women who have metastatic disease will continue to see their oncologist at intervals he or she determines to be appropriate.
Table 1. Recommendations for Breast Cancer Surveillance*
| What Test? |
Who Needs It? |
How Often? |
| Routine visit (history and physical examination) |
All Women |
ASCO: Every 3-6 months for the first 3 years, every 6-12 months for years 4 and 5, and every year thereafter
NCCN: Every 4-6 months for 5 years and every year thereafter
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| Mammography |
Women who had lumpectomy (breast-conserving surgery)
Women who had mastectomy
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6-12 months after completion of radiation therapy
ASCO: Every 6-12 months thereafter
NCCN: Every 12 months thereafter
Yearly mammograms of the opposite breast
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| Breast self-examination |
All Women |
Monthly |
| Gynecologic examination |
All women (with intact uterus)
Women (with intact uterus) taking hormone therapy drugs
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Routine visits as appropriate
Yearly pelvic examination
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| Assessment of bone health |
Women at high risk for osteoporosis (because of type of chemotherapy or treatment with aromatase inhibitors or ovarian suppression/ablation)
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At each visit; baseline bone density scan (if not already done) and periodically thereafter
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*Recommendations according to the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).
Over the years, researchers have determined that many tests once done during follow-up in the absence of any symptoms after breast cancer treatment have not led to extended survival. The benefits of these tests do not outweigh their costs in terms of risk, inconvenience, and financial expense. Tests that may not be recommended in patients without symptoms include:
- Laboratory tests: complete blood count (CBC), liver and kidney function tests Imaging studies: chest x-ray, computed tomography (CT), ultrasound, positron-emission tomography (PET), or breast magnetic resonance imaging (MRI)
- Bone scan
- Tumor markers (CA 15-3, CA 27.29, and carcinoembryonic antigen [CEA])
Bear in mind that your doctor may order one or more of these tests if he or she thinks it is necessary on the basis of your medical history, overall general health, particular treatment you received, or symptoms you may have. Women with metastatic breast cancer will continue to have testing (laboratory tests and imaging studies) to monitor the disease for early signs of progression.
Breast cancer survivors should practice “self surveillance” and pay attention to persistant symptoms that may be a sign of recurrence. Studies have shown that most breast cancer recurrences are discovered by patients between visits to their doctor. If you have any of the following symptoms, contact your doctor or member of your health care team. These symptoms do not necessarily mean that cancer has recurred, but your doctor should evaluate them to be sure.
- New lump in the breast
- Rash on the breast or chest
- Pain, especially in bone, the chest, or the abdomen
- Vaginal bleeding or so-called spotting
- Shortness of breath
- Persistent headache or neurological symptoms
- Persistent coughing
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