Cancer Type: Breast cancer

Introduction

Key Points:

• Follow-up care for breast cancer includes coping with side effects of treatment and lowering the risk of recurrence.
• ASCO’s recommendations for follow-up care include regular visits to your doctor and mammographies.
• People with breast cancer should talk with their doctors about a follow-up care plan and how to coordinate this care between the oncologist and their primary care or family doctor.

To help doctors give their patients the best possible care, the American Society of Clinical Oncology (ASCO) asks its medical experts to develop recommendations for specific areas of cancer care. ASCO developed a clinical practice guideline about follow-up care for breast cancer. This guide for patients is based on ASCO's recommendations.

As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your judgment or that of your doctor. The final decisions you and your doctors make will be based on your individual circumstances.

Recommendations

The purpose of follow-up care for breast cancer is to help maintain good health after treatment, which includes coping with the side effects of treatment, reducing the risk of recurrence (return of the cancer), and watching for signs of recurrence. ASCO's recommendations for breast cancer follow-up care are listed below.

------------------------

Table. Recommendations for Follow-Up Care for Breast Cancer

Medical history and physical examination: Visit your doctor every three to six months for the first three years after the first treatment, every six to 12 months for years four and five, and every year thereafter.

Post-treatment mammography: Schedule a mammogram one year after your first mammogram that led to diagnosis, but no earlier than six months after radiation therapy. Obtain a mammogram every six to 12 months thereafter.

Breast self-examination: Perform a breast self-examination every month. This procedure is not a substitute for a mammogram.

Pelvic examination: Continue to visit a gynecologist regularly. Women taking tamoxifen should report any vaginal bleeding to their doctor.

Coordination of care: About a year after diagnosis, you may continue to visit your oncologist or transfer your care to a primary care doctor. Women receiving hormone therapy should talk with their oncologist about how often to schedule follow-up visits for re-evaluation of their treatment.

Genetic counseling referral: Tell your doctor if there is a history of cancer in your family. The following risk factors may indicate that breast cancer could run in the family:

• Ashkenazi Jewish heritage
• Personal or family history of ovarian cancer
• Any first-degree relative (mother, sister, daughter) diagnosed with breast cancer before age 50
• Two or more first-degree or second-degree relatives (grandparent, aunt, uncle) diagnosed with breast cancer
• Personal or family history of breast cancer in both breasts
• History of breast cancer in a male relative

------------------------

Most breast cancer recurrences are discovered by patients between doctor visits. Tell your doctor if you experience the following symptoms:

• New lumps in the breast
• Bone pain
• Chest pain
• Abdominal pain
• Shortness of breath or difficulty breathing
• Persistent headaches
• Persistent coughing
• Rash on breast
• Nipple discharge (liquid coming from the nipple)

The following tests are not currently recommended by ASCO for regular follow-up care because they have not been shown to lengthen the life of a person with breast cancer:

• A complete blood count (CBC) test and liver and kidney function tests
• Chest x-ray
• Bone scan
• Liver ultrasound
• Computed tomography (CT or CAT) scan
• Fluorodeoxyglucose-positron-emission tomography (FDG-PET) scan
• Breast magnetic resonance imaging (MRI) test
• Breast cancer tumor markers, such as CA 15-3, CA 27.29, and carcinoembryonic antigen (CEA).

What This Means for Patients

The recommendations for follow-up care for breast cancer include regular physical examinations, mammograms, and breast self-examinations. The follow-up care may be provided by your oncologist or primary care doctor, as long as your primary care doctor has communicated with your oncologist about appropriate follow-up care. In addition, patients with a possible or known family history of breast cancer should be referred to a genetic counselor. Use these guidelines to talk with your doctor about an appropriate follow-up care plan for you.

Questions to Ask the Doctor

To learn more about follow-up care for breast cancer, consider asking your doctor the following questions:

• What follow-up care plan would you recommend for me?
• What is the risk that the cancer will recur?
• Based on my personal and family medical history, do I need a referral to a genetic counselor?
• Where can I find more information about follow-up care?

For women receiving hormone therapy:

• Are there any additional symptoms I should watch for?
• What side effects are common with this treatment?
• How often should I schedule additional follow-up visits with the oncologist?

Helpful Links

• Read the entire clinical practice guideline published in the November 1, 2006 Journal of Clinical Oncology (JCO)
• Guide to Breast Cancer
• Genetics of Breast Cancer
• What to Expect When Meeting With a Genetics Counselor

Resources

Good cancer care starts with good cancer information. Well-informed patients are their own best advocates, and invaluable partners for physicians. ASCO’s patient website, Cancer.Net, brings the expertise and resources of the world’s cancer physicians to people living with cancer and those who care for and care about them. ASCO is composed of more than 27,000 oncologists globally who are the leaders in advancing cancer care. All the information and content on Cancer.Net was developed and approved by the cancer doctors who are members of ASCO, making Cancer.Net the most up-to-date and trusted resource for cancer information on the Internet. Cancer.Net is made possible by The ASCO Cancer Foundation, which provides funding for cutting-edge cancer research, professional education, and patient and family support. People in search of cancer information can feel secure knowing that the programs supported by The ASCO Cancer Foundation provide the most thorough, accurate, and up-to-date cancer information found anywhere.

Visit Cancer.Net to find guides on more than 120 types of cancer and cancer-related syndromes, clinical trials information, coping resources, information on managing side effects, medical illustrations, cancer information in Spanish, podcasts, the latest cancer news, and much more. For more information about ASCO’s patient information resources, call toll free 888-651-3038.

Reprinted with permission. © 2011 American Society of Clinical Oncology. All rights reserved. www.Cancer.net