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Do I Still Need Regular Breast Exams

After Treatment for Breast Cancer?

by Vladimir Lange, MD

Breast Cancer image

Every woman who has had breast cancer should have a mammogram once a year, regardless of age.

Even after the most complete treatment for breast cancer, there’s always a chance that cancer will recur. Most recurrences happen two or three years after surgery. The longer you go without a recurrence, the greater are your chances of remaining free of the disease. But you can never say that the cancer has been completely cured.

Because of this possibility, you need regular follow-up visits with a healthcare professional. It could be your family physician, your oncologist, or your breast surgeon. What’s important is to have a single person in charge of the follow-up care. Usually, you’ll be seen as often as every few weeks immediately after treatment, and perhaps only every six months later on. There is no “right” schedule. Eventually, you will probably be down to a single annual visit.

What does follow-up care involve? Most physicians suggest a physical examination to look for signs of local recurrence – new lumps within the breast after lumpectomy, or tiny, hard nodules in the surgical scar after mastectomy.

In addition, mammography will be scheduled on a regular basis, and you may have a number of blood tests that will assess the function of your liver, bone marrow, and other organs, and a chest X-ray. Other tests, such as CEA (a protein found in the blood of people with cancer) and bone scans, are not used routinely.

You need to become familiar with the new look and feel of your breasts so that you can report any changes promptly.

Currently, many experts feel that there is little to be gained by performing multiple tests on people who are asymptomatic – that is people who have no symptoms. Such tests may detect a recurrence a few months earlier, but earlier diagnosis will not change the outcome of whatever treatment you might need. So you can expect to have fewer and fewer tests as the years pass after your initial treatment.

Breast Self Examination
BSE is particularly important for women at higher risk of breast cancer – and that includes you and your first-degree relatives. You need to become familiar with the new look and feel of your breasts so that you can report any changes promptly.

BSE is not a skill that you can learn from a brochure or a shower card. The best way to learn it is from your healthcare provider, or from a good breast self exam DVD.

A thorough BSE should include the following:

Looking Using a mirror, check the shape and size of your breasts and the color and texture of your skin, first with your arms down, then with your arms in the air. Try to learn what’s normal for you so that you can spot any changes immediately.

Feeling Lie down with a folded towel under your shoulder. Extend the arm out at an angle to spread the breast tissue more evenly. Use three middle fingers to examine the entire breast area. Make three dime-sized circles. One just lightly, one deeper, and one deeper still. This will enable you to check the full thickness of your breast. When you’ve finished, lower your arm and examine your armpit for possible lymph node enlargement.

If you had a mastectomy, you are not likely to find a lump within the flap tissue used for reconstruction. Local recurrences are more likely to appear as tiny, firm beads along the incision line. If you had a lumpectomy, you will probably feel irregular lumpiness at the surgical site shortly after the lumpectomy heals.

Clinical Breast Examination
CBE will be part of your regular checkups. The physician will probably spend additional time examining the scar and areas where enlarged lymph nodes may be found – under the arms and around the collar bones.

Mammography
Every woman who has had breast cancer should have a mammogram once a year, regardless of age. If you had a lumpectomy, the films may be more difficult to interpret, so make sure that previous mammograms are available for comparison. If you had a mastectomy, you should have mammograms of the other breast. If you are sensitive near the post-surgical scar, ask the technologist for a Mammopad – a soft sheet of special padding that fits on the mammography device.

MRI
For women with especially dense breasts, or women who present unusual diagnostic challenges, MRI is an effective option. In fact, the American Cancer Society now recommends that all women at high risk of breast cancer (which includes women who already had breast cancer before) should have screening with MRI every year.

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Editor’s Note: Dr. Vladimir Lange, a graduate of Harvard Medical School, is a leading expert in helping women and their families in their battle with breast cancer. His wife, Mandy, also a physician, is a breast cancer survivor.

Excerpted with permission from Be a Survivor: Your Guide to Breast Cancer Treatment, 5th edition, by Vladirmir Lange, MD, copyright © 2010 by Lange Productions.

This article was published in Coping® with Cancer magazine, March/April 2010.