That “one in eight” lifetime risk for breast cancer is scary for every woman but unfortunately, it remains a valid statistic. Too many of my patients have been told (often by me) that they had breast cancer, but with appropriate therapy most are now doing well. Of course, they and I have a continued concern about appropriate follow-up. How intensive and frequent should it be? Is there a point at which a woman who has had breast cancer can “relax” and get the same screening as women who have never had breast cancer?
The American Society of Clinical Oncology recently came out with their updated recommendations for follow-up care for breast cancer survivors; but actually, they made no changes from the guidelines they released in 2006. The Society formed a special practice guidelines committee which then studied outcome data on disease free survival, overall survival, quality of life and cost-effectiveness. (I know the latter may not be that important to women who actually have had this disease but every public health organization has to assess cost.) They studied nine reviews on the topic and five randomized controlled trials. Here are the old, and now new recommendations for follow up of breast cancer survivors:
- A physical exam and history every 3 to 6 months for the first three years after initial therapy. Subsequently a history and physical exam every 6 to 12 months for the next two years, then yearly.
- If breast conserving surgery i.e. lumpectomy was done, the first mammogram should be performed at least six months after completing radiation therapy, followed by a mammogram every 6 to 12 months. Once mammographic findings are stable, mammography can be repeated yearly.
- Monthly self breast exams. Women should report any symptoms such as lumps, bone pain, chest pain, breathlessness, abdominal pain or persistent headaches to a physician.
- Genetic counseling for the following reasons: Ashkenazi Jewish heritage; a history of ovarian cancer at any age in the patient or any first or second degree relatives; any first degree relative with a history of breast cancer diagnosed before the age of 50; two or more first or second degree relatives diagnosed with breast cancer at any age; a patient or relative with diagnosis of bilateral breast cancer; and history of breast cancer in a male relative.
- Regular annual gynecologic care. Women who take tamoxifen should tell their doctor about any vaginal bleeding since they are at higher risk for endometrial cancer.
I assume most of my patients who are breast-cancer survivors are doing all of the above and indeed I make sure they do so when I see them, as do their oncologists and surgeons. But if you or a friend or relative have had breast cancer, please make sure that these guidelines are followed. So many of us have come through this disease and continue on with our normal lives as well as having an expectation for a healthy, long life span. We just have to make sure that our follow-up is appropriate.