Life After Breast Cancer - Survivorship and Follow-up

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Most women want to know what happens after completing treatment for breast cancer.  Here we review the standard follow up including disease and side effect surveillance as well as wellness.

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‍Read the full video transcript below:

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After completing curative therapy for breast cancer, most women want to know, "How do we know I'm cured, and what happens next?" 

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The cornerstone of disease monitoring after successfully completing treatment is a physical exam. Physical exams should happen at least once, but up to four times a year for the first 5 years, and then annually thereafter. 

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While an individual's genetic makeup doesn't change, their family's history can. It's important to periodically screen and update any new additions of cancer diagnoses in the family. Patients with new concerning family history should be referred back to genetics counseling as needed.

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Lymphedema is a condition in which women experience swelling in the arm or the breast after completing surgery and radiation. After completing treatment, women should undergo ongoing education and monitoring for lymphedema and if lymphedema is detected, they should be referred to a lymphedema specialist for therapy. 

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In addition to a physical exam, an annual mammogram is another cornerstone of detecting early signs of recurrence after successfully completing curative treatment for breast cancer. If suspicious findings are detected either on physical exam or on mammograms, then additional testing or more frequent testing may be required. 

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Women who received anthracycline-based chemotherapy may require additional echocardiograms or an ultrasound of the heart periodically. An important note for women who undergo breast reconstruction after mastectomy: there are no standard scans that are part of the routine surveillance after treatment, only physical exams. 

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Similarly, there are no scans recommended for screening for metastases, but scans may be used for signs and symptoms.

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Recommendations for follow-up after endocrine therapy depend on the drug used. For tamoxifen, an annual exam, but no ultrasound, and for an aromatase inhibitor, a bone density scan. 

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Since the vast majority of women with breast cancer are ultimately cured, perhaps the most important thing is that they just return to their normal life. There is evidence that long-term outcomes can be improved by maintaining an active lifestyle, a healthy diet, avoiding alcohol, and maintaining a healthy weight. It's also important for patients to remain engaged with their providers with ongoing communication to minimize the chance that a recurrence is missed.

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This is not medical advice. Talk to your doctor before making medical decisions.

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