Follow-up Care After Breast Cancer Treatment

Many women are relieved to be finished with breast cancer treatment, but also worry about the cancer coming back and can feel lost when they don't see their cancer care team as often.

But for some women with advanced breast cancer, the cancer may never go away completely. These women may continue to get treatments to help keep the breast cancer under control and to help relieve symptoms from it. Learning to live with advanced breast cancer that doesn’t go away can have its own types of stress and uncertainty.

Even if you have completed breast cancer treatment, your doctors still will want to watch you closely, so it’s very important for you to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems and will examine you. Lab tests and imaging tests typically aren't needed after treatment for most early-stage breast cancers. But they might be done in some women who are having symptoms to see if they're the result of the cancer returning or are from treatment-related side effects.

Almost any cancer treatment can have side effects. Some might only last for a few days or weeks, but others might last a long time. Some side effects might not even show up until years after you have finished treatment. Your doctor visits are a good time for you to ask questions and talk about any changes or problems you notice or concerns you have. However, if concerns about your cancer come up between visits, you shouldn't wait until your next scheduled visit. Call your doctor's office right away.

Typical follow-up schedules

Your follow-up schedule can depend on many factors, including the type of breast cancer, how advanced it was when it was found (the stage of the cancer), and how it was (or is being) treated.

• Doctor visits: If you have finished treatment, your follow-up visits will probably be every few months at first. 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.
• Mammograms: If you had breast-conserving surgery (lumpectomy or partial mastectomy), you will probably have a mammogram about 6 to 12 months after surgery and radiation are completed, and then at least every year after that. Women who've had a mastectomy (removal of the entire breast) typically no longer need mammograms on that side. But unless you've had both breasts removed, you still need to have yearly mammograms on the remaining breast. To learn more, see Mammograms After Breast Cancer Surgery.
• Pelvic exams: If you are taking either of the hormone drugs tamoxifen or toremifene and still have your uterus, your doctor will likely recommend pelvic exams every year because these drugs can increase your risk of uterine (endometrial) cancer. This risk is highest in women who have gone through menopause. Be sure to tell your doctor right away about any unusual vaginal bleeding, such as bleeding or spotting after menopause, bleeding or spotting between periods, or a change in your periods. Although this is usually caused by something that isn’t cancer, it can also be the first sign of uterine cancer.
• Bone density tests: If you are taking a hormone drug called an aromatase inhibitor (such as anastrozole, letrozole, or exemestane) for early-stage breast cancer, or if treatment puts you into menopause, your doctor will want to monitor your bone health and may consider testing your bone density.
• Other tests: Other tests such as blood tests and imaging tests (like bone scans, x-rays, or CT or PET scans) are not a standard part of follow-up for most women who've been treated for breast cancer, because they haven't been shown to help them live longer. But one or more of these tests might be done if you have symptoms or physical exam findings that suggest that the cancer might have come back.

If symptoms, exams, or tests suggest your cancer might have returned, imaging tests such as an x-ray, CT scan, PET scan, MRI scan, bone scan, and/or a biopsy may be done.

If the cancer recurrence is confirmed, your doctor may also check your blood for circulating tumor cells (CTCs), or for levels of blood tumor markers such as CA-15-3, CA 27-29, or CEA. Tumor marker levels go up in some women if their cancer recurs or has spread, so if a tumor marker level is high, your doctor might use it to monitor the results of further treatment. But tumor marker levels don’t go up in all women, so these tests aren't always helpful, and they aren't used to watch for cancer recurrence in women without any symptoms.

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include:

• A summary of your diagnosis, the tests that were done, and the treatment you received
• A suggested schedule for follow-up exams and tests
• A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from the breast cancer or its treatment
• A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
• Diet, physical activity, and other lifestyle modification suggestions

Keeping health insurance and copies of your medical records

Even after treatment is finished, it’s very important to keep your health insurance. Tests and doctor visits cost a lot, and even though no one wants to think their cancer might come back, this could happen.

At some point after your treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records so you can give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

If the cancer comes back

If cancer does return, your treatment options will depend on where it comes back, what treatments you've had before, and your current health and preferences. For more information, see Treatment of Recurrent Breast Cancer. 

It’s important to know that women who have had breast cancer can also still get other types of cancer, so it’s important to follow the American Cancer Society guidelines for the early detection of cancer, such as those for colorectal cancer and cervical cancer.

Women who have had breast cancer are actually at higher risk for certain other cancers. To learn more about the risks of second cancers, see Second Cancers After Breast Cancer.