Caring for Breast Cancer Survivors: 8 Things You Need to Know

We see survivors of breast cancer in primary care practice every day. Here, 8 guideline recommendations to help you ensure their continued health.

The American Society of Clinical Oncology (ASCO) provides specific recommendations for follow-up and management of women after primary breast cancer treatment. As women continue to survive and in so many cases return to a high quality of life after a diagnosis of breast cancer, you will see more of them in your primary care practice. Here, esssentials from the ASCO guidelines: 

1. Women who are at high risk for familial breast cancer syndromes should be referred for genetic counseling. For risk factors for familial breast cancer syndromes see "Hereditary Breast Cancer Syndromes: When and Why to Screen and What to Say When you Don't."

2. After receiving breast-conserving therapy, women should have their first mammogram after treatment no earlier than 6 month after radiation therapy and every 6 to 12 months for surveillance of abnormal findings.

3. Breast MRIs, chest radiographs, bone scans, CT scans, or PET scans are not indicated in breast cancer surveillance.

4. Complete blood cell counts and chemistry profile are not indicated for routine surveillance.

5. Tumor markers CEA, CA15-3, and CA 27.29 are not recommended for routine surveillance.

6. Women should have a careful history and physical every 3 to 6 months for the first 3 year after primary therapy, then every 6 to 12 months for the next 2 years, and then annually by a physician experienced in cancer surveillance and breast examinations.

7. Regular gynecologic follow-up is recommended for all women. Patients who are taking tamoxifen have a higher risk for developing endometrial cancer and should be advised to report any vaginal bleeding.

8. Patients who develop chemotherapy-induced ovarian failure and those treated with aromatase inhibitors for breast cancer are at higher risk for osteoporosis. For these patients, DXA scans are recommended at baseline with periodic follow-up to evaluate risk of fracture, although the interval of screening is not clear.

References:

  • Khatcheressian JL, Hurley P, Bantug E, et al for the American Society of Clinical Oncology. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Mar 1;31(7):961-5. doi: 10.1200/JCO.2012.45.9859
  • Gralow JR, Biermann JS,Farooki A,et al. NCCN Task Force Report: bone health in cancer care.J Natl Compr Canc Netw. 2009;7(suppl 3):S1–S35.