ACS Releases Long-term Care Guideline for Breast Cancer Survivors

The American Cancer Society and the American Society of Clinical Oncology have released a new Breast Cancer Survivorship Care Guideline to help breast cancer survivors and their primary care providers better manage their long-term care.

The guideline was published December 7, 2015 in CA: A Cancer Journal for Clinicians, a journal of the American Cancer Society. It provides detailed recommendations for how and when to test for new or returning cancers, managing side effects, making healthy lifestyle changes, and coordinating care among primary care providers and specialists.

The guideline is the third in a series of cancer survivorship guidelines developed by the American Cancer Society. The first two made recommendations for survivors of prostate cancer and survivors of colorectal cancer. The Society is developing survivorship care guidelines for other cancer types as well, based on the number of survivors and the severity of health problems survivors face.

An estimated 3.1 million breast cancer survivors are living today in the United States. The average age at diagnosis is 61 years; therefore it is important that long-term survivorship care is managed in coordination with health problems associated with aging.

Testing for cancer

The most common treatment for breast cancer is surgery, often in combination with radiation, chemotherapy, and/or targeted therapy. After treatment, the new guidelines recommend that survivors get regular follow-up tests and physical exams to report any new symptoms and coordinate after-treatment care. During these visits, providers should encourage survivors who take anti-estrogen therapy (tamoxifen, aromatase inhibitors, or ovarian suppression therapy) to keep taking the medicines for as long as they are prescribed.

The recommendations say women who have had breast conserving surgery (lumpectomy) should get annual mammograms on both breasts. Women who have had one breast removed should get annual mammograms on the remaining breast. Breast cancer survivors do not need routine MRIs unless they are at high risk for another breast cancer. This includes women with a known BRCA1 or BRCA2 gene mutation. Imaging tests (other than mammography) and lab tests to check for breast cancer recurrence are not needed unless a woman has symptoms. Symptoms of recurrence can vary widely; talk to your doctor about what to watch for.

Survivors should also follow the American Cancer Society’s early detection guidelines to check for other cancers. Unless there is a family history or known genetic syndrome, most breast cancer survivors are at average risk for other cancers including colon cancer and cervical cancer and should follow the same testing schedule for their age and gender as the general population.

Managing side effects

Treatment for breast cancer can cause physical and emotional side effects including body image concerns, lymphedema (severe swelling in the arm), heart problems, fatigue, thinking problems, loss of bone density, pain, nerve damage (peripheral neuropathy), infertility, sexual issues, and premature menopause. It’s important to discuss these side effects with a medical provider so they can be evaluated and treated when possible.

It is not unusual for people who’ve had cancer to experience anxiety or depression. Feelings of sadness or distress should be discussed with a doctor, who can evaluate whether they are signs of clinical depression. Clinical depression can lower a woman’s quality of life, and also make her less able to take care of her own health. There are many ways to treat clinical depression, including medicine, counseling, or a combination of both.

Encouraging healthy behaviors

The breast cancer survivorship guidelines recommend that primary care doctors talk to survivors about their lifestyle habits and give them advice on how to make changes, if needed. A healthy lifestyle after a breast cancer diagnosis can reduce symptoms and improve quality of life, and may help lower the risk of some cancers. Healthy behaviors include:

  • Getting to and staying at a healthy weight by limiting high-calorie foods and beverages, and getting more physical activity.
  • Regardless of current weight, aiming for at least 150 minutes of physical activity every week, with a doctor’s approval. This should include strength training at least 2 days a week.
  • Eating a diet rich in vegetables, fruits, and whole grains, and low in saturated fats, with adequate calcium and vitamin D. Survivors who face challenges to good nutrition should talk to their doctor or ask for a referral to a registered dietician.
  • Limiting alcohol consumption to no more than 1 drink per day.
  • Avoiding tobacco.

Coordinating medical care

When cancer treatment ends, patients should ask their oncologist for a written follow-up care plan that they can share with their primary care doctor and other doctors. It should include an explanation of which provider – oncologist, primary care doctor, or other specialist – should be in charge of cancer-related and other medical care.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. Published December 7, 2015 in CA: A Cancer Journal for Clinicians. First author: Carolyn D. Runowicz, MD, Florida International University, Miami, FL.


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