Follow Up Tests
You must continue medical appointments after treatment, so your health care team can keep an eye on your health, especially when it comes to follow-up tests. Here’s what you can expect after treatment:
Self Breast Exam Step/Lying Down (Susan G. Komen Breast Cancer Foundation):
- Oncology exam every four to six (4-6) months for the first five (5) years, then every 12 months after that. Clinical breast exam at least every 12 months.
- Mammogram every 12 months. If you had surgery and radiation therapy instead of mastectomy, have a mammogram of the treated breast six to 12 (6-12) months after radiation ends. Then have one of both breasts every 12 months. If you have had bilateral mastectomies, then you will no longer have mammograms.
- Pelvic exam and digital rectal exam (35 and older) every 12 months. New recommendations suggest that if you have had normal Pap tests, you can go three (3) years between Pap tests, but an annual pelvic exam is still recommended.
- Bone health should be checked every two (2) years after the age of 50, and before that if you are taking an aromatase inhibitor (such as Arimidex, Femara, or Aromasin). Women who have not gone through menopause will not take these medications, and usually don’t need to have their bone density tested until after menopause.
- Monthly breast self-exam. You should do this even if you have little or no breast tissue after surgery. Be sure to get up behind the collar bone and into the armpit.
Self-Breast Exam Step/Standing (Susan G. Komen Breast Cancer Foundation):
- Lie down with a pillow under your right shoulder.
- Use the pads of the three middle fingers of your left hand to check your right breast.
- Press using light, medium and firm pressure in a circle without lifting your fingers off the skin.
- Follow an up-and-down pattern.
- Feel for changes in your breast area, above and below your collarbone and in your armpit.
- Repeat on your left breast using your right hand.
On the side where you had surgery:
- Stand in front of a mirror and look for any changes.
- Hold your arms at your sides.
- Hold your arms over your head.
- Press your hands on your hips and tighten your chest muscles.
- Bend forward with your hands on your hips.
- See your doctor or nurse if you notice any of these things in your breasts:
- - Lump, hard knot or thickening
- - Swelling, warmth, redness or darkening
- - Change in size or skin
- - Dimpling or puckering of the skin
- - Nipple discharge that starts suddenly
- - New pain in one spot that does not go away
- - Get to know how the skin, tissue and scar look and feel.
- - Look for changes from one month to the next.
- - If you have concerns, tell your doctor.
Many women take medicines for about five years to help keep the cancer from coming back (this time frame may change in the future). Medicines are used if the breast cancer cells were “estrogen hormone receptor positive.”
The medicine is usually a pill that taken once a day. Recent studies show these medicines increase the amount of women who survive disease-free for five years by as much as 40 percent, so it’s important to take these medicines as scheduled. The four most common medicines in this group are:
How They Work
- Tamoxifen (an older medicine that is used for women who have not gone through menopause, or older women who do not tolerate the other medications).
- Arimidex, Aromasin, and Femara (these medications are newer and called aromatase inhibitors. These medications are only used in women who have gone through menopause)
Many breast cancers need estrogen to grow. The drugs listed above all work by keeping the normal estrogen in the body from aiding tumor growth. There are some risks and side effects with each drug and a person may not have any of them, or several.
Common Risks and Side Effects of Breast Cancer Drugs:
- Hot flashes and sweats
- Nausea, indigestion, or diarrhea
- Muscle aches or joint pain
- Hair thinning
- Risk of osteoporosis
- Vaginal dryness
- A general “not feeling very good”
One of the more common complaints by women who take these drugs is joint, muscle and/or bone pain. If this is a problem, contact your doctor. You may need tests to see whether or not the pain is related to the medicine. If the pain is from the medicine, there are a number of things that can be tried.
To Fight Pain:
To Decrease Bone-Related Side Effects of Aromatase Inhibitors (for women who have gone through menopause):
- Try over-the-counter medicine for pain and inflammation, like Tylenol or Ibuprophen. Always talk with your doctor before starting any kind of medication.
- Think about prescription medications for pain and inflammation. These should be prescribed for you by your doctor.
- Begin weight-bearing exercise. Start slowly after talking with your doctor about it.
- Wear supportive shoes.
- Do regular stretching and joint exercises.
- Try using heat and massage in the area of pain, but not on your surgical area or the arm on that side.
- Take a Vitamin D 3 and calcium supplement.
- Do not smoke.
- Limit alcohol to one drink per day.
Most of the above listed problems are mild. There are other less common side effects that may be more serious. If you are having problems taking your medicines or have concerns about taking these medications, talk with your health care team. Think about the risks and the benefits as you talk. There are many things that can be done to help, including changing your medicine or adding a new one to help with the side effects. There may also be some non-drug treatments that may help. Many of these problems also get better after taking the medicine for a while. DO NOT TO STOP TAKING ANY MEDICATION WITHOUT TALKING TO YOUR DOCTOR.
Several of these medications are now available in a generic form and are therefore less expensive. Talk with your physician and pharmacist about changing to the generic. Most women have been able to do so without any issues.
There are some rare, but serious side effects that you should be aware of, such as blood clots (Tamoxifen), jaw necrosis, and the development of other cancers. Symptoms that may go along with serious problems from taking these medicines need to be reported to your doctor and checked as soon as possible.
Contact Your Doctor If You Experience The Following Problems:
General Medicinal Advice:
- Pain, redness or swelling in the lower leg
- Shortness of breath
- Chest pain
- Sudden severe headache
- Trouble speaking or moving
- Unusual female bleeding
- Jaw pain after major dental work
- Allergic reaction (rash, swelling - particularly of the face and mouth)
These medicines are usually taken once a day. It is best to take them at the same time each day, either morning or evening. And do the following:
- Keep out of children’s reach.
- Store in the original container.
- Keep at room temperature, away from moisture, direct heat and light.
- Return the medicine to the pharmacy for safe disposal, if you are taken off of it by your doctor.
- Refill before you run out, so that you don’t miss a dose.
- Tell all other doctors (including dentists) that you are taking this medication.
When Do You Need To Seek Help?
Remember it’s vital for you to have regular planned check-ups with your health care team, who will work with you to have follow-up blood tests, mammograms and other needed tests. Keep a record of your tests. If you notice any changes in your breast(s) or symptoms, contact your health care team.
The American Cancer Society/Stay Healthy:
National Cancer Institute/Drugs Approved for Breast Cancer:
Breast Cancer.Org/Drugs for Treatment and Risk Reduction:
Videos to Watch:
Beyond Breast Cancer: What Next?
So what does life look like after you’re through with treatment? Hear as survivorship expert Dr. Don Dizon discusses the perspectives, problems and promises you might encounter along the way.