Follow Up after Treatment for Breast Cancer

When you reach the end of treatments that involve regular visits to hospital, such as chemotherapy or radiotherapy, you will still have regular follow-up appointments. These may be more frequent at first, becoming less so as time goes on.

Regular follow up is strongly recommended after treatment for breast cancer. The purpose of follow-up care for breast cancer is to help maintain good health after treatment, which includes coping with side effects of treatment, advice on exercise, activity and diet, reducing the risk of recurrence and watching for signs of recurrence.

Women diagnosed with early breast cancer have an increased risk of the cancer coming back in the breast (or the chest wall after mastectomy) and of developing breast cancer in the opposite breast.

After your treatment for breast cancer you will be regularly followed up by your breast surgeon, medical oncologist and perhaps also radiation oncologist. Regular physical and mammograms can help find any recurring or new cancer in the breast at an early stage. Regular follow-up makes sure that if breast cancer comes back in the breast it is promptly detected and treated.

Regular follow up also allows your doctor to check for and manage any side effects from treatment that might develop after you have finished treatment. Other issues that may need to be considered are those related to fertility including pregnancy, contraception and menopausal symptoms. In patients with a significant family history of breast cancer, consideration should be given to referral to a genetic service for further assessment. Women who develop arm lymphoedema need referral for appropriate treatment.

Some women find it reassuring to have regular check-ups, while other women feel very anxious around the time of their follow up appointments. Both reactions are normal.

What do follow up appointments involve?

Appropriate follow up after a diagnosis of early breast cancer involves regular physical examinations and mammograms.

Physical examinations

A physical examination of the breast/chest where the cancer was and of your opposite breast will be done by your doctor.

Mammograms and/or Ultrasound scans:

If you have had breast conserving surgery: a mammogram (+/- ultrasound, if appropriate) is recommended 12 months after diagnosis and continued annually. If you have had a mastectomy a mammogram (+/- ultrasound) of your remaining opposite breast is also recommended once a year. Breast MRI is not currently recommended as part of routine breast cancer follow up imaging.

Recommended follow up:

The time between appointments may vary between doctors/hospitals and will also differ for each person depending on their individual situation. A commonly recommended follow up programme is set out below. Not everyone may need to be monitored this closely.

  1st 2 years 2-5 years After 5 years
History & examination Every 3/4 months Every 6 months Every year
Mammogram 12 months post diagnosis Every year Every year

Tell your doctor if you experience the following symptoms:

  • New lumps in the breast, on the chest wall or under the arm.
  • Unusual changes at the site of your surgery or in the scar itself
  • Bone pain eg pain in the back or hips that does not improve with painkillers and which is often worse at night.
  • Chest pain
  • Abdominal pain
  • Rash on the breast
  • Unexplained weight loss and a loss of appetite or a constant feeling of nausea
  • A dry persistent cough or a feeling of breathlessness.
  • Severe headaches – usually worse in the mornings.

Key points:

  • It is more likely that you will find a cancer that has come back or spread than your doctor.
  • If you notice a new lump or experience new symptoms, you should report this immediately, not wait until your next routine visit. Your Breast Care Nurse is a good contact to use in this situation.
  • Everyone develops aches and pains. It will be hard for you not to worry if you do experience pain or other symptoms. In most cases these will not mean the cancer has returned.

Other Scans and Tests

Apart from regular mammograms, you won’t normally have routine scans and tests. This is because several large studies have shown this is not useful in finding further cancer spread and doesn’t improve overall survival. Further investigations will not be done routinely unless you have symptoms which need checking out. If you have had an early menopause due to your breast cancer treatment or your specialist team has concerns about the effect your treatment might have on your bone strength, it may be recommended that you have regular bone density scans every 1-2 years.

The following tests are not currently recommended for regular follow-up care because they have not been shown to lengthen the life of a person with breast cancer:

  • Blood tests- including liver function tests and tumour markers
  • Chest x-ray
  • Bone scan
  • Liver ultrasound
  • Computed tomography (CT) scan
  • Positron emission tomography ( PET) scan

These recommendations are not meant to replace your doctors’ judgment, and recommendations will vary depending on your individual circumstances. If you have any queries contact your Breast Care Nurse for advice.

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