Follow-up after treatment for breast cancer

Follow-up care lets your healthcare team keep track of your health for a period of time after treatment ends. This important part of cancer care is often shared among the cancer specialists and your family doctor. They will help you recover from treatment side effects and monitor you for any signs that the cancer has come back (recurred).

Follow-up care may not seem that important to you, especially if your treatment was long or very hard. You may find the idea of follow-up care stressful because it reminds you of your cancer experience or because you are worried about what a test might reveal. Talk to your healthcare team about how you feel and about why follow-up matters. Your healthcare team is there to help.

Don't wait until your next scheduled appointment to report any new symptoms and symptoms that don't go away. Tell your healthcare team if you have:

• a new lump in the breast or under your arm
• changes in the size, shape or texture of your breast
• new or worse pain, especially in your legs, hip or back
• a cough that won't go away
• unexplained weight loss
• fatigue that gets worse over time
• swelling (called lymphedema) in your hand or arm on the same side of the body as the tumour
• headaches that won't go away
• numbness or tingling in your hands or feet
• vaginal bleeding or spotting
• shortness of breath

The chance that breast cancer will come back is greatest within 5 years, so you will need close follow-up during this time. People who are diagnosed with breast cancer also have a higher risk of developing cancer in the opposite breast as well as colon cancer, ovarian cancer and uterine cancer.

Follow-up visits for breast cancer are usually scheduled:

• every 3 to 6 months for the first 5 years
• once a year after 5 years

During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping.

Your doctor may do a physical exam, including:

• a clinical breast exam
• checking the surgical area to see how well it healed
• checking the scar to look for signs that the cancer has come back
• feeling the lymph nodes under the arm, in the neck and around the collarbone
• looking for any swelling in the hand and arm on the same side of your body as the surgery
• checking your lungs
• feeling your abdomen for any swelling or fluid

The only test that is done as a regular part of follow-up care is mammography. It is done on both breasts (if you had breast-conserving surgery, or BCS) or on your remaining breast (if you had a mastectomy). Mammography is scheduled 6 months after treatment for breast cancer is finished, then once a year after that.

Tests to check how well your heart is working may also be done because some drugs used to treat breast cancer can cause heart problems.

There is a chance that your bones will become fragile and thin (called osteoporosis) if you take an aromatase inhibitor. You may have a bone density scan when you start an aromatase inhibitor and on a regular basis while you take this drug.

If you are taking tamoxifen, there is a very small chance that you could develop cancer in the lining of your uterus. Your doctor will do a pelvic exam every year to check for any changes to your uterus.

No other tests are done if you do not have any signs or symptoms that breast cancer has come back. If there are symptoms of a breast cancer recurrence, your doctor may order one or more of the following tests:

• blood chemistry tests to see if the cancer has spread to the liver or lungs
• a bone scan to see if the cancer has spread to the bones
• a chest x-ray
• an ultrasound of your abdomen
• a CT scan

If the cancer has come back, you and your healthcare team will discuss your treatment and care.

The following are questions that you can ask the healthcare team about follow-up after treatment for cancer. Choose the questions that fit your situation and add questions of your own. You may find it helpful to take the list to the next appointment and to write down the answers.

• What is the schedule for follow-up visits?
• How often is follow-up scheduled with the cancer specialist?
• Who is responsible for follow-up visits?
• What will happen at a follow-up visit?
• What tests are done on a regular basis? How often are they done?
• Are there any symptoms that should be reported right away? Who do I call?
• Who can help me cope with long-term side effects of treatment?