Many women are relieved or excited to be finished with breast cancer treatment. But it can also be a time of worry for women who fear their cancer could come back, or who feel lost without the same frequency of visits with their cancer care team.
Even after you have completed breast cancer treatment, your doctors will want to watch you closely. It’s very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems. They may do exams and lab tests or imaging tests to look for signs of cancer or treatment side effects.
Almost any cancer treatment can have side effects. Some might only last for a few days or weeks, but others might last a long time. Some side effects might not even show up until years after you have finished treatment. Visits with your doctor are a good time for you to ask questions and talk about any changes or problems you notice or concerns you have. However, if you have additional concerns about your cancer, you do not have to wait until your next scheduled visit. You can call your doctor immediately.
Typical follow-up schedules
- Doctor visits: At first, your follow-up doctor visits will probably be scheduled for every few months. The longer you have been free of cancer, the less often the appointments are needed. After 5 years, they are typically done about once a year. Mammograms: If you had breast-conserving surgery, you will get a mammogram about 6-12 months after surgery and radiation are completed, and then at least every year after that. If you had a mastectomy you will still need to have yearly mammograms on the remaining breast.
- Pelvic exams: If you are taking either of the hormone drugs tamoxifen or toremifene and still have your uterus, you should have pelvic exams every year because these drugs can increase your risk of uterine cancer. This risk is highest in women who have gone through menopause. Be sure to tell your doctor right away about any unusual vaginal bleeding, such as vaginal bleeding or spotting after menopause, bleeding or spotting between periods, or a change in your periods. Although this is usually caused by something that isn’t cancer, it can also be the first sign of uterine cancer.
- Bone density tests: If you are taking an aromatase inhibitor (anastrozole, letrozole, or exemestane) for early stage breast cancer, or if you go through menopause as a result of treatment, your doctor will want to monitor your bone health and may consider testing your bone density.
- Other tests: Other tests such as blood tests and imaging tests (like bone scans and chest x-rays) are not a standard part of follow-up because they haven’t been shown to help a woman treated for breast cancer live longer. But they might be done if you have symptoms or physical exam findings that suggest that the cancer might have come back. These and other tests may also be done as part of evaluating new treatments by clinical trials.
If symptoms, exams, or tests suggest a possible recurrence of your cancer, imaging tests such as an x-ray, CT scan, PET scan, MRI scan, bone scan, and/or a biopsy may be done. Your doctor may also look for circulating tumor cells in the blood or measure levels of blood tumor markers such as CA-15-3, CA 27-29, or CEA. The blood levels of tumor markers go up in some women if their cancer has spread to bones or other organs such as the liver. They are not elevated in all women with recurrence, so they aren't always helpful. If they are elevated, your doctor might use them to monitor the results of therapy.
It’s important to know that women who have had breast cancer can also still get other types of cancer. In fact, women who have had breast cancer are at higher risk for certain other cancers. Because of this, it’s important to follow the American Cancer Society guidelines for the early detection of cancer, such as those for colorectal cancer and cervical cancer. To learn more about the risks of second cancers and what you can do about them, see Second Cancers After Breast Cancer.
Ask your doctor for a survivorship care plan
Talk with your doctor about developing a survivorship care plan for you. This plan might include:
- A suggested schedule for follow-up exams and tests
- A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
- A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
- Diet and physical activity suggestions
If the cancer comes back
If cancer does return, your treatment options will depend on where it comes back, what treatments you've had before, and your current health and preferences. For more information on how recurrent cancer is treated, see Treatment of Recurrent Breast Cancer.
© 2018 American Cancer Society. All Rights Reserved. Retrieved from http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-after-follow-up on October 26, 2018. Reprinted with permission.