Cancer survivors require follow-up care, being informed about what to expect following cancer treatment is important. This knowledge may go a long way to help you and your family plan, make lifestyle changes, and important decisions.
Regular follow up is strongly recommended after treatment for breast cancer. Follow-up care for breast cancer helps to maintain good health following treatment, this includes surveillance of local or distant recurrence, management of any side effects of treatment, guidance on lifestyle changes such as exercise and diet, and observation of emotional health.
Women diagnosed with early breast cancer have an increased risk of the cancer coming back in the breast (or the chest wall after mastectomy) and of developing breast cancer in the opposite breast. After your treatment for breast cancer, you will be regularly followed up by Dr Gault, medical oncologist and also your radiation oncologist. Regular physical checks and mammograms can help find any recurring or new cancer in the breast at an early stage. Regular follow-up ensures that if the breast cancer reoccurs in the breast it is promptly detected and treated.
Cancer Australia (2010) defines the aims and objectives of follow up as:
- Detect and treat local recurrence
- Deal with adverse effects of treatment
- Provide psychological support
- Screen for new primary breast cancer
- Review and update family history
- Observe outcomes of therapy
- Review treatment including the potential for new therapies.
The type of cancer and type of treatment you had, along with your individual overall health will dictate your follow-up care plan.
Dr Gault’s normal follow-up protocol for consultations is as follows:
- every three months during the first year,
- six monthly for the second year after treatment
- once a year after that for a period of at least 5 years.
At these visits, your doctor will:
- Look for side effects from treatment
- Check your breast and armpit
- Review your medical history
- Give you a physical examination
Your doctor may run follow-up tests including:
- Mammogram and ultrasound (yearly)
- Blood tests
- MRI or CT (if indicated)
Regular follow-up also allows your doctor to check for and manage any side effects from treatment that might develop after you have finished treatment. Issues that may arise and require due consideration are those related to fertility including pregnancy, contraception and menopausal symptoms.
If a significant family history of breast cancer were noted, consideration for further assessment and referral to a genetic service would be given in this phase of treatment. The development of arm lymphoedema is also monitored during these consultations and may require referral for appropriate treatment.
Important to note: Report a new lump or if you experience new symptoms immediately, do not wait until your next appointment, call our friendly staff to make an appointment at your earliest convenience.
Tell your doctor if you experience the following symptoms:
- New lumps in the breast, on the chest wall or under the arm.
- Unusual changes at surgery site
- Bone pain e.g. pain in the back that does not improve with painkillers.
- Chest pain
- Abdominal pain
- Breast rash
- Unexplained weight loss and a loss of appetite
- A dry persistent cough
- Unusual headaches
Scans and Tests
Further investigations will not be done routinely unless you have symptoms that need investigation. If you have had an early menopause due to your breast cancer treatment or your specialist team has concerns about the effect your hormone therapy treatment might have on your bone strength, you may be required to have regular bone density scans.
The following tests have not been shown to lengthen the life of a person with breast cancer. They are therefore not routinely included in follow-up care for breast cancer.
- Blood tests- including liver function tests and tumour markers
- Chest x-ray
- Bone scan
- Liver ultrasound
- Computed tomography (CT) scan
- Positron emission tomography (PET) scan
Being involved in decisions about your medical care and lifestyle is one way to help you feel back in charge after being treated for cancer. Research has shown that people who feel more in control feel and function better than those who do not. We encourage you to be an active partner with Dr Gault, to be compliant with treatment and to seek help from all members of your health care team as an important first step to your survivorship.