It was quite sad to see this 68 year old lady come to the clinic yesterday. She was diagnosed with left breast cancer two years back and was treated with MRM, adjuvant chemotherapy and hormonal therapy at a private hospital. After her treatment was completed, she did not visit the oncologist again thinking that she has been cured and for the last 6 months she had been harboring this growth over the chest wall, which turned out to be a local recurrence.
Patients tend to think that when the treatment is over, they are cured of the disease, but that is not the case. Patients need to visit their oncologists/ doctors regularly after the completion of their treatment and this case points out the importance of correct and regular follow-up after breast cancer treatment.
The current guidelines regarding follow-up of breast cancer patients are:
- History & physical examination: Every three to six months for the first three years after the first treatment, every six to 12 months for years four and five, and every year thereafter.
- Mammography: If mastectomy has been done, then annual mammograms of the opposite breast. If breast conservation has been done, then B/L mammography should be done annually.
- Breast self-examination. Perform a breast self-examination every month. This procedure is not a substitute for a mammogram.
- Pelvic examination. If the patient is on Tamoxifen, annual gynecological check-up should be done because tamoxifen can increase the chances of uterine cancer.
One reason which deters patients from going on regular follow-ups is the fact that some doctors order unnecessary tests during these visits. One should be aware that the following tests are NOT recommended for regular follow-up care of breast cancer patients:
- Blood tests like CBC, LFT, KFT
- Chest x-ray
- Bone scan
- CT scan
- FDG PET scan
- Breast MRI
- Breast cancer tumor markers – CA 15-3, CA. 27.29, CEA