Completing treatment can be both stressful and exciting. You will be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer.

It may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. For more information on this please refer to our document, Living With Uncertainty: The Fear of Cancer Recurrence.

It is also important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. Should your cancer come back our document, When Your Cancer Comes Back: Cancer Recurrence gives you information on how to manage and cope with this phase of your treatment.

Follow-up care

After your treatment is over, it is very important to keep all follow-up appointments. During these visits, your doctors will ask about symptoms and may do physical exams, and order lab tests or imaging tests. Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments. This is the time for you to ask your health care team any questions you need answered and to discuss any concerns you might have.

Almost any cancer treatment can have side effects. Some may last for a few weeks to several months, but others can be permanent. Don't hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.

At first, these visits are scheduled every 4 to 6 months. The longer you are free of cancer, the less often you will need visits. After 5 years, visits are usually once a year. If you had breast-conserving surgery, you will need to keep on having mammograms every year.

If you are taking tamoxifen, you should have a pelvic exam every year. Be sure to tell your doctor right away if you have abnormal vaginal bleeding because the drug can increase the risk of uterine cancer. If you are taking an aromatase inhibitor, your doctor might want to have your bone density checked.

If anything suggests that the cancer might have come back, the doctor will want to do more tests. If cancer does come back, the treatment will depend on the place of the cancer and what treatments you've had before. Treatment could involve surgery, radiation, hormone therapy, or chemo.

Lymphedema

Lymphedema is a swelling of the arm and/or caused by fluid build-up. It can occur any time after treatment for breast cancer-- right after surgery, months, or even years later. There is no way to know who will and will not develop lymphedema.

With care, lymphedema can often be avoided or kept under control. Injury or infection of the arm on the affected side can cause lymphedema or make it worse. Tell your doctor right away about any swelling, tightness, or injury to the hand or arm. There are ways to help prevent problems. For example, most doctors suggest that women do not have blood drawn from or blood pressures taken on the arm on the side of the lymph node surgery or radiation. To learn more, see our document, Lymphedema: What Every Woman With Breast Cancer Should Know.

Quality of life

Women who have had treatment for breast cancer should know that they can have a normal quality of life after treatment is over. Many studies have proven this. But women who have had chemo may notice a slight decrease in certain areas of function.

Some studies suggest that younger women tend to have more problems with the stresses of breast cancer and its treatment. Some feel isolated. Also, chemo may cause early menopause which needs to be managed. There may be sexual problems, too. These women might benefit from counseling and support groups directed to younger breast cancer survivors.

Emotional aspects of breast cancer

You may have been going through so much during treatment that you could not focus on anything else. Once your treatment ends, you may find yourself overwhelmed by emotions. This happens to a lot of women. This is an ideal time to seek out support. You need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support groups, or individual counselors. The cancer journey can feel very lonely, but you don't have to go it alone. If you aren't sure who can help, call us and we can put you in touch with a group or other resource.

Body image

A woman's choice of treatment is likely influenced by her age, the image she has of herself and her body, and her hopes and fears. For example, some women may choose breast-conserving surgery with radiation over a mastectomy for body image reasons. On the other hand, some women choose mastectomy regardless of the effect on their body image. They may be more concerned about the effects of radiation than how the breast will look after treatment.

Many women with breast cancer also find themselves dealing with the fact that treatment changed the way they look. Some changes may be short term, such as hair loss. But even short-term changes can have a major effect on how a woman feels about herself. A number of options are available to help women cope with hair loss, including wigs, hats, scarves, and more. For a list of some companies that sell wigs and other hair accessories, call the American Cancer Society 1-800-227-2345 and ask for the document, Breast Prostheses and Hair Loss Accessories List. On the other hand, some women may choose to show off their baldness as a way to identify themselves as breast cancer survivors.

Whatever the changes you may face, it's important to know that there is advice and support out there to help you cope with these changes. Talking with your doctor or nurse is often a good starting point. There are also many support groups, such as our Reach to Recovery program. Call us to learn more about programs in your area.

Breast forms and bras vs. breast reconstruction

Some women who have had a mastectomy might choose breast forms instead of reconstruction. Your doctor will tell you when you are ready to be fitted for a form. Prices vary quite a bit. Take time to shop for one that looks good and fits well.

The right bra for you may very well be the one you have always worn. You can often have your usual bra adapted for a breast form. Be sure to check your insurance to see what is covered and how to file a claim. Also, ask your doctor to write prescriptions for your form and any special bras. When buying the forms or bras, have the bills marked "surgical."

Be aware that if you submit an insurance claim for a breast form or a bra, the company might not also cover reconstruction if you decide you want this procedure in the future. Get all the facts before turning in any claims.

Be sure to call your local ACS Reach to Recovery volunteer about any questions you have. She will give you suggestions, more reading material, and advice. Remember that she's been there and may understand better than most people.

Sexuality

Concerns about sexuality are often very worrisome to a woman with breast cancer. Aside from body image, some treatments for breast cancer, such as chemo, can change a woman's hormone levels and may reduce her sexual interest or response. It can be especially hard if a woman in her 20s or 30s finds she has breast cancer. Choosing a partner and having children are often very important during this period.

A woman's partner can also find the diagnosis distressing. Partners are often worried about how to express their love physically and emotionally after treatment, especially after surgery.

Treatment for breast cancer can affect the pleasure from touching the breast. In a reconstructed breast, the feeling of pleasure from touching the nipple is largely lost because a rebuilt nipple has much less feeling than a natural one. The skin of the breast itself may be less sensitive, too. But some feeling may return over time.

Some women still enjoy being touched around the area of the surgery; others dislike being touched there and may no longer even enjoy having the remaining breast touched. A few women have chronic pain in their chests after radical mastectomy. Supporting these areas with pillows and avoiding positions where your weight rests on your chest or arms during sex may help.

Breast surgery or radiation to the breasts does not physically decrease a woman's sexual desire. Nor does it decrease her ability to have normal intercourse or to reach orgasm. Some good news from recent research is that most women with early stage breast cancer have adjusted well within a year. They report a quality of life much like that of women who never had cancer.

Please remember that every woman reacts in her own way. Your feelings are not right or wrong, they are simply yours. For more information, see Sexuality for the Woman With Cancer.

Pregnancy after breast cancer

In the past, many doctors advised breast cancer survivors not to become pregnant for at least 2 years after treatment. Although only a few studies have been done, nearly all have found that pregnancy does not increase the risk of the cancer coming back after successful treatment. If you are thinking about getting pregnant, be sure to talk to your doctor first. Sometimes counseling can help you sort out the complex issues about motherhood and breast cancer survivorship.

Post-menopausal hormone therapy after breast cancer

In the past doctors have offered PHT (also called hormone replacement therapy or HRT) to women after breast cancer treatment to help with severe symptoms of menopause. But a recent study has shown that women taking PHT after treatment for breast cancer are much more likely to have the cancer come back or to develop a new breast cancer. For this reason, most doctors now feel that it is unwise not a good idea for women who have been treated for breast cancer to use PHT. Women may want to talk with their doctors about other ways to handle symptoms of menopause.

Seeing a new doctor

At some point after your cancer diagnosis and treatment, you may find yourself in the office of a new doctor. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have the following information handy and always keep copies of all your medical records for yourself:

• a copy of your pathology report from any biopsy or surgery
• if you had surgery, a copy of your operative report
• if you were hospitalized, a copy of the discharge summary that every doctor must prepare when patients are sent home from the hospital
• if you had radiation therapy, a summary of the type and dose of radiation and when and where it was given
• if you had systemic therapy (hormone therapy, chemo, or targeted therapies), a list of your drugs, drug doses, and when you took them

Lifestyle changes to consider during and after treatment

Having cancer and dealing with treatment can be time-consuming and emotionally draining, but it can also be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term.

Make healthier choices

Think about your life before you learned you had cancer. Were there things you did that might have made you less healthy? Maybe you drank too much alcohol, or ate more than you needed, or smoked, or didn't exercise very often.

Now is not the time to feel guilty or to blame yourself. However, you can start making changes today that can have positive effects for the rest of your life. Not only will you feel better but you will also be healthier.

You can start by working on those things that you feel most concerned about. Get help with those that are harder for you. For instance, if you are thinking about quitting smoking and need help, call our Quitline^® tobacco cessation program at 1-800-227-2345.

Diet and nutrition

Eating right can be a challenge for anyone, but it can get even tougher during and after cancer treatment. If you are still in treatment and are having eating problems related to your treatment, please ask for a copy of Nutrition for the Person with Cancer.

One of the best things you can do after treatment is to put healthy eating habits into place. You will be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Try to eat 5 or more servings of vegetables and fruits each day. Choose whole grain foods instead of white flour and sugars. Try to limit meats that are high in fat. Cut back on processed meats like hot dogs, bologna, and bacon. If you drink alcohol, limit yourself to 1 or 2 drinks a day at the most. And don't forget to get some type of regular exercise. The combination of a good diet and regular exercise will help you maintain a healthy weight and keep you feeling more energetic.

Weight

For a woman with breast cancer, getting to and staying at the right weight is one of the most important things she can do. Some studies have found that women who are very overweight when their cancer is found are more likely to have their cancer come back. And they are also more likely to die of the cancer. Studies have also found that gaining a lot of weight after cancer also had the same effect. But not all studies showed this result.

Rest, fatigue, work, and exercise

Fatigue is a very common symptom in people being treated for cancer. This is often not an ordinary type of tiredness but a “bone-weary” exhaustion that doesn't get better with rest. For some, this fatigue lasts a long time after treatment, and can discourage them from physical activity. However, exercise can actually help you reduce fatigue. Also, recent studies suggest that women who have had breast cancer and who are active have lower rates of the cancer coming back and lower death rates than those who are not active.

If you are ill and need to be on bed rest during treatment, it is normal to expect your fitness, endurance, and muscle strength to decline some. Physical therapy can help you maintain strength and range of motion in your muscles, which can help fight fatigue and the sense of depression that sometimes comes with feeling so tired.

Any program of physical activity should fit your own situation. Talk with your health care team before starting, and get their opinion about your exercise plans. Then, try to get an exercise buddy so that you're not doing it alone.

If you are very tired, though, you will need to balance activity with rest. It is okay to rest when you need to. For more information about fatigue, please see our publications, Fatigue in People with Cancer and Anemia in People With Cancer.

Exercise can improve your physical and emotional health.

• It improves your cardiovascular (heart and circulation) fitness.
• It makes your muscles stronger.
• It reduces fatigue.
• It lowers anxiety and depression.
• It makes you feel generally happier.
• It helps you feel better about yourself.

And long term, we know that exercise plays a role in preventing some cancers. The American Cancer Society recommends that for breast cancer prevention, women take part in at least 1 moderate to vigorous physical activity for 45 to 60 minutes on 5 days or more of the week. Moderate activities are those that take about as much effort as a brisk walk. Vigorous activities use larger muscle groups, make you sweat, and make you notice an increase in your heart rate and breathing.

Last Medical Review: 09/29/2009
Last Revised: 09/29/2009