Breast Cancer: Follow-up Care and Monitoring
Approved by the Cancer.Net Editorial Board, 09/2021
ON THIS PAGE: You will read about your medical care after cancer treatment for early-stage and locally advanced breast cancer is completed and why this follow-up care is important. Use the menu to see other pages.
Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.
Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. Annual mammography and physical exams are the only recommended surveillance strategy in people in good health who have been treated for curable breast cancer. More intensive follow-up in people with no symptoms has not been proven to improve outcomes.
Breast cancer can come back, or recur, in the breast or other areas of the body. Generally, a recurrence is found when a person has symptoms that last longer than 2 weeks or an abnormal finding during a physical examination. Annual mammograms are also recommended after a diagnosis of breast cancer. The symptoms depend on where the cancer has recurred and may include:
A lump under the arm or along the chest wall
Pain that is constant, worsening, and not relieved by over-the-counter medication, such as nonsteroidal anti-inflammatory medications (NSAIDs)
Bone, back, neck, or joint pain, fractures, or swelling, which are possible signs of bone metastases
Headaches, seizures, dizziness, confusion, personality changes, loss of balance, nausea, vomiting, or changes in vision, which are possible signs of brain metastases
Chronic coughing, shortness of breath, or trouble breathing, which are possible symptoms of lung metastases
Abdominal pain, itchy skin or rash, or yellow skin and eyes from a condition called jaundice, which may be associated with liver metastases
Changes in energy levels, such as feeling ill or extremely tired
Having a low appetite and/or weight loss
Nausea or vomiting
Rash or skin changes on the breast or chest wall
Changes in the shape or size of the breast, or swelling in the breast or arm
It is important that your surgeon explain what your breast will feel like after surgery and, when used, radiation therapy. Over time, the breast will soften and change. But knowing what your breast will feel like can help you understand what is “normal” and what is not. If you have any questions or concerns about a symptom, you should talk with your doctor.
Follow-up care is also important for screening for other types of cancer. In some instances, patients may be able to visit a survivorship clinic that specializes in the post-treatment needs of people diagnosed with breast cancer.
Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, neurocognitive testing, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.
Learn more about the importance of follow-up care.
Surveillance and monitoring for signs and symptoms of recurrence
One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Treatment for early-stage or locally advanced breast cancer is given to get rid of as many cancer cells in the body as possible. However, cancer recurs because small areas of cancer cells that don't respond to treatment may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.
Many survivors feel worried or anxious that the cancer will come back after treatment. While it often does not, it’s important to talk with your doctor about the possibility of the cancer returning. Most breast cancer recurrences are found by patients between doctor visits. The American Society of Clinical Oncology (ASCO) does not recommend routine screening for cancer at distant sites.
During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return and will help you make decisions about your treatment. Learn more about coping with the fear of recurrence.
Your doctor will ask specific questions about your health at your follow-up care appointments. Regular follow-up care recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.
The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.
Managing long-term and late side effects
Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.
Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests as part of your follow-up care to help find and manage them.
Long-term effects of surgery. After a mastectomy or lumpectomy to treat early-stage or locally advanced breast cancer, the breast may be scarred and may have a different shape or size than before surgery. Or, the area around the surgical site may become hardened. If lymph nodes were removed as part of the surgery or affected during treatment, lymphedema in the arm, chest wall, or breast may occur, even many years after treatment. This is a life-long risk for survivors.
Long-term effects of radiation therapy. Some survivors experience breathlessness, a dry cough, and/or chest pain 2 to 3 months after finishing radiation therapy. That is because radiation therapy can cause swelling and a hardening or thickening of the lungs called fibrosis. These symptoms may seem similar to the symptoms of pneumonia but do not go away with antibiotics. The symptoms can be treated with medications called steroids. Most people fully recover with treatment. Talk with your doctor if you develop any new symptoms after radiation therapy or if the side effects are not going away.
Long-term effects of trastuzumab and/or chemotherapy. People who received trastuzumab or certain types of chemotherapy called anthracyclines may be at risk of heart problems. Talk with your doctor about the best ways to check for heart problems. Patients treated with chemotherapy also have a risk of other long-term side effects, such as menopausal symptoms, fatigue, chemobrain, permanent numbness and tingling of the fingers and toes, and weight gain.
Long-term effects of hormonal therapy. People taking tamoxifen should have yearly pelvic exams, as this drug can slightly increase the risk of uterine cancer. This risk increases with the duration of administration of tamoxifen. Tell your doctor or nurse if you notice any abnormal vaginal bleeding or other new symptoms, as you may need additional tests to learn more about the cause. People who are taking an aromatase inhibitor (AI), such as anastrozole, exemestane, or letrozole, should have a bone density test periodically during treatment, as these drugs may cause some bone weakness or bone loss.
In addition, people recovering from early-stage or locally advanced breast cancer can have other side effects that may continue after treatment. However, these can often be managed with medications or other options. People recovering from early-stage or locally advanced breast cancer may also experience the following long-term effects:
Menopausal symptoms, such as hot flashes
Depression and anxiety
Vaginal dryness and a lowered sex drive are also common side effects during or after treatment for early-stage and locally advanced breast cancer. Talk with your doctor about these or other sexual health concerns. Treatment is individualized for the patient and the type of cancer and may be best managed by a gynecologist working with your oncologist.
Keeping personal health records
You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. At the conclusion of active treatment, ask your doctor to provide you with a treatment summary and a survivorship care plan.
This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor, another health care professional, or a specialized survivorship clinic. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.
If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.
Posted in: Post Treatment, Survivorship