Dr. MJ Bazos MD,
care after Breast Cancer Treatment
My treatment for breast cancer is almost
finished. Will I need further medical care?
Everyone who has had treatment for breast cancer
should continue to visit the doctor regularly for the following
• To receive ongoing support. Your
first visit after treatment will give you an opportunity to discuss problems,
deal with any side effects of treatment and help you to find emotional or social
support if you need it. You will also work out a schedule with your doctors for
• To establish your current health
status. About 4 to 6 months after treatment, when inflammation in your
breast has settled down, you can expect to have mammography and a physical
examination. This will show where you stand after treatment and serves as a
“baseline” for comparison if changes occur at any time in the
future. If you do not already practise breast self-examination, you may want to
learn this technique now.
• To detect problems early. Cancer
can return in the same breast, or a new one can start in the other breast. If
this occurs, regular physical examination and mammography will help detect it at
an early stage.
Who will be responsible for my follow-up
On your early visits, you will usually see the
specialist(s) who have supervised your treatment: the surgeon, the medical
oncologist or the radiation oncologist. At first, some or all of them may wish
to see you. Later, with your participation and agreement, responsibility may be
transferred to one of them or to your family doctor. The important thing is that
the members of your medical team coordinate your care. They should keep you
fully informed, and you should know exactly what follow-up arrangements have
been made and who is responsible for carrying them out.
How often should I visit the
Canadian treatment centres often recommend
visits every 6 months for 2 to 5 years after surgery. However, no one schedule
has been proved best for everyone, and the timing should be adjusted to your own
needs. You may wish to make additional visits if you need further advice or
support, or if a new problem comes up. It is recommended that yearly visits
continue for life.
What will happen on my followup
Every visit should include an updating of your
medical history and a physical examination. Yearly visits should also include
• Medical history. Your doctor will
want to know about any side effects of treatment such as swelling or tenderness
in your breasts, stiffness in your shoulder or swelling in your arm since your
last visit. If you’re taking tamoxifen as part of your treatment and
haven’t had a
hysterectomy, you should tell your doctor if any
vaginal bleeding (even slight spotting) has occurred. This is because the risk
of endometrial cancer (cancer in the lining of the uterus) is slightly higher
for women taking tamoxifen.
• Physical examination. The main
purpose of this examination is to look for recurrence of cancer and for new
cancers in either breast. Your doctor will examine both breasts, the lymph nodes
in the armpit and collarbone areas, the chest wall and the abdomen. Your arm
will also be examined for “lymphedema” (swelling of the arm due to a
build-up of lymphatic fluid, which can occur after removal of armpit lymph
nodes) or any infection associated with it.
Shouldn’t I have regular tests to make
sure the cancer hasn’t come back somewhere else?
No. The only regular test you need is
mammography. Regular mammography is recommended to detect any return of cancer
in the same breast or any new cancer in the opposite breast. The chance of a
cure is better when these cancers are found early. If cancer does spread to
other parts of the body, life expectancy is the same whether it is detected
early or not. So routine use of other tests — such as bone and liver
scanning, chest x-rays, blood tests and tests for tumour markers — is
unnecessary and not recommended.
What if I get new symptoms or feel
something is wrong
After treatment for breast cancer, many women
will experience pain or other unpleasant symptoms. If these problems come and
go, or disappear within a week or so, they are very unlikely to be related to
cancer. However, sometimes a problem does not go away. If you have any new,
persistent symptoms, you should report them immediately, without waiting
for your next regular appointment. Such symptoms may include the
• new, persistent
• discovery of a
lump in either breast,
unusual changes at the site of your surgery or in the scar
• a persistent tired
• loss of
• tingling or
numbness in the arm or hand,
• swelling of the arm (even slight
swelling can signal lymphedema, which can be painful and is often easier to
treat if recognized early) or
• any new symptom that is unusual,
severe or persistent.
I would like to find someone to talk over
these issues with, between visits to my doctor.
Support of this sort can be valuable in addition
to any comfort it may give.
I’ve had breast cancer treatment, and
now I’m having pain. Does this mean the cancer has come
The cause of the pain will have to be
investigated because the pain may be from some other source that has nothing to
do with breast cancer or its treatment. Or it may be a result of the surgery,
radiotherapy or chemotherapy you have had. A third possibility is that the
cancer has returned.
What types of pain may come from
One cause of pain is the “postmastectomy
syndrome.” This occurs because removal of a lump can damage nerves in the
area. This problem is more common after a total mastectomy (removal of the whole
breast) but can also follow a lumpectomy (removal of just the cancer),
especially if you’ve also had lymph nodes removed in the armpit area.
Usually, this type of pain is not severe and will gradually improve. Swelling of
the arm (lymphedema) is another condition that can cause discomfort and pain.
Removal of lymph nodes from the armpit during surgery can damage the channels
which drain lymph from the arm. This leads to swelling and can be painful,
especially if the arm becomes infected.
Could my pain be related to anticancer
Some drugs may cause painful conditions,
including bladder inflammation (cystitis), numbness and tingling (peripheral
neuropathy), mouth ulcers (mucositis) and aching joints. Taking drugs
intravenously may also cause painful inflammation of the veins
What about pain caused by
One type of pain is called “brachial
plexopathy.” A burning or stabbing pain is felt in the arm, shoulder or
hand when these areas are touched, or they may feel “different”
— either numb or very sensitive. There may also be weakness in the arm,
especially if the pain has been going on for a long time. This pain usually
means that cancer has come back in the lymph nodes behind the collarbone.
Rarely, this kind of pain may be just a side effect of radiotherapy or surgery.
Careful investigation is necessary to rule out cancer, although your doctor may
be able to provide some reassurance by pinpointing which nerves are involved.
This is because cancer usually attacks some nerve branches and not others. Pain
due to cancer is often centred around the shoulder and seems to spread to the
elbow, the forearm and the fourth and fifth fingers. Persistent pain in the
bones is often a signal that the cancer has recurred and is spreading. If you
have lasting pain at any time, you should consult your doctor immediately.
Although the bones are the most common site in which cancer returns
(metastasizes), pain can also occur from cancer spreading to the nerves and
Should medication get rid of all my
If the pain is caused by cancer, anticancer
treatment such as radiotherapy or chemotherapy may give you the relief you need.
Otherwise, anti-pain medications can usually provide good pain
The medication should be chosen in such a way
that the pain is controlled rapidly and completely.