Guidelines for the care of breast cancer survivors

These guidelines offer recommendations for the long-term follow-up and care of breast cancer survivors.

The 5-year survival rate for breast cancer is currently close to 90%. Thanks to early diagnosis and care, an ever-increasing number of patients are surviving for long periods of time following treatment. Therefore, it is essential to monitor and support the quality of life of these patients. There are no set guidelines, however, for the follow-up and care of long-term breast cancer survivors. The American Cancer Society and the American Society of Clinical Oncology reviewed recent research and developed the following guidelines for the treatment and care of breast cancer survivors.

It is recommended that patients undergo a physical exam every 3-6 months for the first 3 years after therapy, every 6-12 months for the next 2 years, and annually after that. Patients who had one breast removed should have an annual mammogram on the other breast. Patients who had a lumpectomy should have an annual mammogram on both breasts. Magnetic resonance imaging (MRI, uses magnetic fields to image the organs) or laboratory (blood) tests are not recommended unless the patient is showing symptoms. Patients should be educated as to what symptoms to watch for.

Patients should be encouraged to follow their hormone therapies (treatments that block the hormone estrogen, which in many women can cause tumor growth). Hormone therapies (such as tamoxifen or aromatase inhibitors) can reduce the risk of recurrence when used for 5 to 10 years.

Prosthetic devices or breast reconstructive surgery should be considered for women unhappy with their appearance following treatment. Treatments can be used to soften post-radiation lumps in the skin.

Patients should be encouraged to make lifestyle changes (losing weight, starting a regular exercise program, stopping smoking) to reduce risks of certain late effects (those that begin after treatment has ended). Lymphedema (swelling due to a blockage of the fluid that removes waste from the body) and cardiovascular (heart and blood vessel) related risks can both be reduced with lifestyle changes.

Bone loss is experienced by up to 80% of patients. Lifestyle changes can improve bone health, as can calcium supplements. Postmenopausal women should have a bone scan every 2 years. Treatments such as bisphosphonates (such as Fosamax) can be used, but these also can cause side effects. Regular exercise should also be recommended for patients experiencing pain following treatment. Pain medications such as non-steroidal anti-inflammatories (ibuprofen, naproxen) and acupuncture may also be helpful.

Cognitive impairment (“chemobrain”) is reported by up to 35% of patients after chemotherapy. Cognitive training can be helpful for these patients. Patients should also be monitored for depression, anxiety and fatigue, as these have been reported by a large number of patients. Any factors that might be causing the problems outside of cancer treatment should be addressed, and the patients should then be recommended for behavioral therapy and lifestyle changes.