You were diagnosed a decade ago. Surgery took your breast, chemotherapy took your hair. The hair grew back, the breast did not. The scars, both inside and out will be yours to carry until the day you die. You waited with bated breath for years for something bad to happen. Nothing did…you are a survivor. What now? Ten years later what do you need checked, what should you and your doctors look for.
The first thing you should know…you are not alone. There are 2.3 million breast cancer survivors in the United States today and the number keeps growing. These patients are experiencing the normal issues of aging, compounded by the long-term effects of having had cancer and treatment. So why even go for follow ups? Are they really necessary? There are several reasons to visit with your doctor after treatment. First and foremost in most patients mind is the possibility of the breast cancer returning. This is most common in the first five years but can still happen decades later. A new and different cancer can occur. Your doctor will also check for side effects of treatment. These side effects can be ones that occur right after treatment and ones that can develop years later.
Since the risk of cancer recurring goes down over time your check ups will become less and less often. After five years you will only need to see your doctor once a year. Based on the Institute of Medicine’s recommendations, your doctor will check and up date your history, perform a physical exam, and order any x-rays that may be needed during your visits. Of course you still need your mammogram once a year. Blood work is recommended only if you have had abnormal values initially, like being anemic after chemotherapy. It is recommended that breast cancer patients be screened for osteoporosis. They should also talk regularly with their doctor about nutrition, diet, obesity, and sexual health.
Now which doctor do you see? You have your primary care doctor and quite a few specialists. There have actually been a number of studies which have looked at patients who were followed by their primary care doctor after the first year verses patients who were followed by their specialists. The studies showed that there was no advantage to the patients who were seeing the specialists in terms of finding new cancers or recurrences. In fact the American Society of Clinical Oncology’s guidelines suggest that patients who want to follow with their primary care doctor can and should do so after the first year of follow up with the specialists. The studies showed that patients who did their check ups with their primary care doctors received more preventive care. Of course your primary doctor has to be comfortable with this role. The recommendations are that you choose the physician you feel most comfortable with and whom you feel listens to your concerns.
Dr. Kris Gast is a Board Certified Radiation Oncologist who has been in practice 21 years, the last 13 years at Fort Smith Radiation Oncology.