Survivorship: Follow-Up Care

The following are general guidelines for breast cancer follow-up and management after primary treatment (American Society of Clinical Oncology):
 

History and
Physical exam


 

Every 3–6 months for years 1–3, then every 6–12 months for years 4–5, then yearly thereafter.

Breast self-exam


 

Monthly. At every visit, women should be counseled for symptoms of recurrence (see symptom list below).

Mammogram


 

Women who have had breast-conserving surgery (that is, lumpectomy) should have a post-treatment mammogram at 1 year after the initial mammogram, but no sooner than 6 months following completion of radiation therapy. Yearly bilateral mammograms are recommended unless otherwise indicated based on findings following surgery and radiation treatment.

Pelvic exam


 

Regular yearly gynecologic care is recommended for all women. Women who still have their uterus and who are taking Tamoxifen are at increased risk for developing endometrial cancer (cancer of the uterus) and are advised to report any vaginal bleeding to their health care provider. Longer follow-up intervals may be appropriate for women who have had their uterus and ovaries removed.

Tests not recommended for Routine Follow-Up


 

Routine blood tests*: CBC (complete blood count), CMP (complete metabolic panel), or BMP (basic metabolic panel)

Imaging studies*: Chest x-ray, bone scan, PET scan, liver ultrasound, CT scan, breast MRI

Breast cancer tumor markers*: CA-15-3, CA-27.29, or CEA

*These tests are now recommended for surveillance testing ONLY when symptoms are reported that indicate a need for testing. Your healthcare provider will order the test(s) when indicated.


Symptoms That Should Be Reported to Your Healthcare Provider

Breast or Chest Wall Changes
  • Change in size, shape, or contour
  • Clear or bloody nipple discharge
  • Nipple inversion
  • A new lump that feels different from the surrounding tissue in the breast, chest wall, or underarm area
  • Thickening of the breast tissue or skin of the breast or chest wall
  • Skin changes, including dimpling or retraction (pulling of the skin inward), scaly appearance, orange peel appearance, rash, redness, or discoloration
Body or General Health Changes
  • New lump or thickening in the area above the collarbone
  • New bone pain that is different than pre-existing conditions, such as arthritis or fibromyalgia
  • Chest pain with shortness of breath
  • Chronic cough
  • Persistent abdominal pain or abdominal bloating
  • New frequent or chronic headaches, dizziness, fainting, or rapid changes in vision
  • Increasing fatigue unrelated to treatments
  • Inability to control urine or bowels
  • Persistent nausea or loss of appetite
  • Unintended weight loss


The best and most common way for breast cancer recurrence to be detected is through communication between you and your healthcare provider. Do not hesitate to report to your provider any changes you notice.


Reference: American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline, by Runowicz C.D, Leach C.R, et al., JCO 34(6):611-635. www.jco.ascopubs.org/content/early/2015/12/07/JCO.2015.64.3809.full