What happens after all the treatment is done? Most women ask how they will know if their cancer comes back and how they will be monitored during the years ahead. To begin with, many possible tests can be performed. While some are important, such as mammography, others, such as CAT scans and bone scans, do not contribute to longer survival rates and may lead to unnecessary anxiety, additional tests, and biopsies. The American Society of Clinical Oncology (ASCO) has published guidelines, "A Patient's Guide to Follow-Up Care for Breast Cancer." You can view this document on their website. (See asco.org, the "People Living with Cancer" section.)

It is important to see your cancer specialist for regular checkups. Medical oncologists and surgeons often do these checkups, while radiation oncologists may see the patients only for the first one to two years. Sometimes the checkups can be rotated among your team of cancer specialists. Although your family doctor should continue to see you for routine physical exams, it is still important to see a cancer specialist, who will be particularly aware of issues important to breast cancer survivors.

During the first three years after finishing treatment, you should have a checkup no less than every three to six months. During these visits it is important for you to share with your doctor any new symptoms you may be experiencing. For example, do you have any breast lumps or changes in your breast or chest region? Are you experiencing any persistent bone pain? Any problems breathing? Any abdominal pain or bloating that does not go away? Unexplained weight loss? In addition to carefully examining the breasts, your doctor will do a full physical exam.

After the first three years, these visits can be less frequent, perhaps every six to twelve months for the next two years. After five years, an annual checkup is sufficient for a routine exam. However, if you are experiencing any new symptoms, you should let your doctor know and arrange to be seen for evaluation. Although most recurrences happen in the first two to three years, they can happen much later on, even up to ten or more years after initial diagnosis and treatment.

Mammography is an important part of your follow-up. If you are treated with breast-conserving therapy, then you will have a mammogram of the treated breast six months after completing radiation. After that, mammograms are generally done yearly, although your doctor may recommend them at additional times if any questions arise during your clinical breast examination. If you have had a mastectomy, then every year you will need a mammogram of the opposite breast.

Routine gynecological examinations are also important, and women taking tamoxifen need to be especially careful about telling their doctors about any abnormal bleeding.

If you have any symptoms, or if your doctor finds any abnormalities on your physical exam, then appropriate tests will be ordered. These may include blood tests, x-rays, bone scans, MRIs, or CT scans. However, if you are feeling fine and your exam is normal then these tests are not recommended.

The work of identifying a blood test that is sensitive and specific enough to be helpful in follow-up is an active area of current research but, unfortunately, at this time no such test exists. Blood tests called tumor markers CA 27-29, CA 15-3, and CEA are not recommended for routine follow-up because they are often normal when cancer has already spread, and they may be abnormal when there are no clinical signs of cancer. In other words, frequent false positive and false negative results make them unreliable.


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