For many women with breast cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are leading full lives. Living with Uncertainty: The Fear of Cancer Recurrence gives more detailed information on this.
For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other treatments to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty. When Cancer Doesn't Go Away has more about this.
When treatment ends, your doctors will still want to watch you closely. It is very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you may have and may do exams and lab tests or x-rays and scans to look for signs of cancer or treatment side effects.
Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life. This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.
At first, your follow-up appointments will probably be scheduled for every 3 to 6 months. The longer you have been free of cancer, the less often the appointments are needed. After 5 years, they are typically done about once a year. If you had breast-conserving surgery, you will get a mammogram about 6 months after surgery and radiation are completed, and then at least every year. Women who had a mastectomy should continue to have yearly mammograms on the remaining breast.
If you are taking tamoxifen or toremifene, you should have pelvic exams every year because these drugs can increase your risk of uterine cancer. This risk is highest in women who have gone through menopause. Be sure to tell your doctor right away about any abnormal vaginal bleeding, such as vaginal bleeding or spotting after menopause, bleeding or spotting between periods, or a change in your periods. Although this is usually caused by a non-cancerous condition, it can also be the first sign of uterine cancer.
If you are taking an aromatase inhibitor for early stage breast cancer, your doctor will want to monitor your bone health and may consider testing your bone density.
Other tests such as blood tumor marker studies, blood tests of liver function, CTs, bone scans, and chest x-rays are not a standard part of follow-up because they don’t help a woman treated with breast cancer live longer. But they will be done (as indicated) if you have symptoms or physical exam findings that suggest that the cancer has recurred. These and other tests may also be done as part of evaluating new treatments by clinical trials.
If symptoms, exams, or tests suggest a recurrence, imaging tests such as an x-ray, CT scan, PET scan, MRI scan, bone scan, and/or a biopsy may be done. Your doctor may also look for circulating tumor cells in the blood or measure levels of blood tumor markers such as CA-15-3, CA 27-29, or CEA. The blood levels of tumor markers go up in some women if their cancer has spread to bones or other organs such as the liver. They are not elevated in all women with recurrence, so they aren't always helpful. If they are elevated, your doctor might use them to monitor the results of therapy.
If cancer does recur, your treatment will depend on the location of the cancer and what treatments you've had before. It may mean surgery, radiation therapy, hormone therapy, chemotherapy, targeted therapy, or some combination of these. For more information on how recurrent cancer is treated, see “Treatment of invasive breast cancer, by stage.” For more general information on dealing with a recurrence, see When Your Cancer Comes Back: Cancer Recurrence.
It is also important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
Last Revised: 02/22/2016