Dr. MJ Bazos MD, Patient Handout
Follow-up 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 reasons:
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 long-term care.
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 care?
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 doctor?
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 visits?
Every visit should include an updating of your medical history and a physical examination. Yearly visits should also include mammography.
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 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 following:
new, persistent pain,
persistent coughing,
discovery of a lump in either breast,
unusual changes at the site of your surgery or in the scar itself,
a persistent tired feeling,
loss of appetite,
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.

Where can I find support?
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 after
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 trial?
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.