Comprehensive Breast Care
Follow-Up Care
Once you have completed the local phase of your treatment, a meticulous regimen of follow-up care will begin and
will continue for your lifetime. The purpose is to both monitor the healing process and to watch for a possible
recurrence of your cancer. Complications that may arise during the healing process are usually resolved quickly
and easily, and the possibility of breast cancer recurrence becomes less likely with the passage of time. Even
so, certain basic components of follow-up care, such as breast self-examination, clinical breast examination, and
mammography, should continue for the rest of your life, just as they would if you'd never had cancer at all.
Who's in Charge?
By the time you've completed your treatment, you have come in contact with several specialists who may continue
to be involved in some facet of your care. You have been in contact with your surgeon, radiation oncologist, and
medical oncologist. For follow-up, some women choose their surgeon, some their medical oncologist, but, in any
case, a breast specialist should be in charge of your ongoing breast care. Regular breast follow-up requires a
lifetime commitment.
You should continue to see your practitioner for general care and for other health problems. Many women also continue
to see their gynecologists.
Breast Self-Examination (BSE)
Breast self-examination should become a part of your regular routine. (See
diagrams below.) If you're still menstruating, it should be performed once a month, three or four days after
your period has ended. If you've already been through menopause, or are experiencing irregular periods, you should
do it once a month, coinciding with some other monthly routine so that you won't forget. You may even choose to
mark your calendar for the first of each month as a constant reminder.
If you haven't done it in the past, you may wish to seek instructions from your gynecologist or surgeon. The process
is much the same after surgery as before for women who have chosen breast conserving treatment. Women who have
undergone breast reconstruction should ask their surgeon how to distinguish suspicious areas that need further
investigation from small lumps or ridges that are the result of surgery
Physical Examinations
The frequency of physical examinations, including clinical breast examinations, may differ depending on the
type of your breast cancer or its stage at the time of diagnosis. In some cases, your surgeon will want to examine
you about every three months for the first year, three times a year for the next two years, and twice a year thereafter.
These follow-up intervals vary from surgeon to surgeon. In addition, you should continue to see your gynecologist
on a regular basis and should be followed regularly by your internist or medical oncologist.
Mammograms
You should have a mammogram once a year of both breasts if you've had a lumpectomy, or of the unaffected breast
if you've had a mastectomy. In some cases, a physician may recommend a mammogram more than once a year on a breast
that has undergone breast conserving treatment.
In any case, breast self-examination, clinical breast exams, and mammography are essential parts of ongoing
care.
Blood Tests
Certain blood tests are helpful in determining your general state of health. Blood chemistries are useful to
determine the possibility of recurrence in the bones or liver. Other blood tests, referred to as tumor
marker tests, may be performed to determine the possibility of recurrence.
Other Tests
Some physicians will recommend an annual chest X-ray to make sure your cancer has not spread to the lungs. Other
tests, such as bone scans, CT scans, sonograms,
and MRIs are usually performed after breast cancer treatment only when there is reason
to suspect a recurrence.
Surveillance for Other Cancers
We urge you not to neglect the possibility of other cancers, such as uterine (endometrial), ovarian, and colorectal cancer, where your risk is increased because of a personal history of breast cancer. Endometrial cancer, cancer of the lining of the uterus - especially important to monitor if you are taking tamoxifen - requires regular gynecological follow-up. Early detection is extremely effective against endometrial and colorectal cancer. Please discuss cancer surveillance with your physician.
2. Use the finger pads of the three middle fingers on your left hand to feel for lumps or thickening. Your finger pads are the top third of each finger.
3. Press hard enough to know how your breast feels. If you're not sure how hard to press, ask your health care provider. Learn what your breast feels like most of the time. A firm ridge in the lower curve of each breast is normal.
4. Move around the breast in a set way. You can choose either the circle (A), the up and down line (B), or the wedge (C). Do it the same way every time. It will help you to make sure that you've gone over the entire breast area, including the armpits, and to remember how your breast feels each month.
5. Now examine your left breast using the right hand finger pads. Next check your breasts while standing in front of a mirror right after you do your BSE each month. You might also want to do an extra BSE while you are in the shower. Your soapy hands will glide over the wet skin, making it easy to check how your breasts feel.
WHEN BREAST CANCER RECURS
When a cancer has developed in the breast itself it is called a primary cancer. Any subsequent breast cancer near the original finding is called a local recurrence. Additional surgery and/or radiation therapy may then be recommended. If you have a local recurrence after breast conserving treatment, the breast may then be treated by mastectomy. Studies have shown that women who choose breast conserving treatment first, and then have a mastectomy, will have the same long-term outcome. If breast cancer cells are detected in other parts of the body, this is called metastasis (distant recurrence). When this happens systemic chemotherapy and/or hormone therapy are the treatments of choice.