Dr. MJ Bazos MD,
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
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
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
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 between
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
• unusual changes at the site of your
surgery or in the scar itself,
• a persistent tired
• loss of
• tingling or numbness in the arm or
• 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.
Where can I find
It has long been known that patients who have a
good network of social and emotional support feel better. There is now some
evidence that this kind of support can not only help control problems like pain,
nausea and depression but may even prolong life in the long term
breast cancer has been diagnosed. Good support
is part of good cancer care. It can take many forms, including regular visits to
a health professional, interaction with other women who have had breast cancer
or simply talking things over with a relative or a good friend. Any or all of
these can make a great deal of difference. Ask your doctor about breast cancer
support groups and advocacy groups in your area. The people in these groups know
what you’re going through and know how to help in a way no one else can.
You can also call your local branch of the Canadian Cancer Society or the Cancer
Information Service, toll-free at 888 939-3333. The family counselling or social
work department at your regional cancer centre will also be able to help you
find support groups.
What is a clinical
My doctor has mentioned that I could
participate in one.
A clinical trial is a carefully designed
research study that usually involves comparing one cancer treatment with
another. At some time you may be invited to take part in such a trial. Whether
you join the trial is entirely up to you. Just about everything that we already
know about breast cancer treatment comes from previous clinical trials. Yet,
many questions about breast cancer treatment are still unanswered. Since there
is still so much left to learn, new trials are urgently needed to plan the best
care for the future. If you wish to add to knowledge in this way, ask your
doctor about possible trials you could join.