Follow-up after breast cancer treatment
Follow-up checks
There are three main reasons for patients being seen in hospital for follow-up after treatment of breast cancer:
1 To detect a cancer that returns or a new breast cancer that develops as early as possible
2 To detect and treat side effects and problems that occur as a result of treatment
3 To give psychological support
To detect a cancer that returns or a new breast cancer that develops as early as possible
As we have stressed earlier in the book early detection is paramount in effecting a successful treatment. The chances of cancer returning in most women are, however, extremely small. The best way of detecting further disease in the breasts is by having regular follow-up mammograms. Most women do not require regular follow-up clinical examination or regular clinic visits as most recurrences are found on the mammograms or by the patients themselves.
To detect and treat side effects and problems that occur as a result of treatment
This includes side effects of drugs but also problems related to your surgery such as mismatch between the two breasts after breast-conserving surgery or problems with your scar after mastectomy.
The most common of these is extra tissue at the ends of the mastectomy scar, particularly at the end of the scar under the arm. These extra portions of tissue are known as ‘dog’s ears’ and can be trimmed at a second operation to leave a flatter and more comfortable scar.
Other problems after surgery include a swollen arm (lymphoedema) which develops in 1 in 20 of those who have all the lymph nodes removed.
To give psychological support
Psychological support is necessary because it is very common for women to be anxious or depressed the first few years after a diagnosis of breast cancer.
Breast care nurses play an important role in supporting patients during treatment and after treatment finishes. You should have contact details of your breast care nurse and you should phone them if you experience any problems, physical or psychological.
Continuing support
The chances of the cancer returning are now lower than they have ever been. Although you will have regular visits for the first two years to have an examination by a doctor or nurse, the chances of them finding anything wrong is very small. After the first one to two years you will get regular mammograms but do not need a clinic visit.
It is important that you remain alert to problems and report anything abnormal that you feel to your doctors or nurses as soon as you discover a problem. Each year a mammogram will be organised – which is the best way of detecting new problems at an early stage.
You will not have regular X-rays or scans to look for cancer elsewhere in the body because this is not worthwhile. The major reason is that the chances of finding disease are very small, so the tests are unnecessary.
At any hospital appointment you should report all problems that you are experiencing, including all the side effects of any drugs that you are taking.
You will be asked how you are feeling and coping. It is important to be honest and let the doctors or nurses know of any anxieties or worries. You may be given a questionnaire to complete to assess how you are feeling and what effect the breast cancer is having on your life.
You should have regular mammograms for the rest of your life even if you do not attend a breast clinic. Discuss with your doctors or nurses how you can ensure that this is organised and where you should attend.
Hormone treatments for breast cancer may continue for up to 10 years. If you are on prolonged treatment you will need regular scans of your bone density to check that you do not develop osteoporosis (thinning of the bones). Your hospital doctor, specialist nurse or GP will organise this.
