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After being treated for breast cancer, it’s healthy and normal to have fear or anxiety about your cancer returning. It’s natural to wonder whether a new ache, pain, or twinge you experience could be breast cancer-related.
Once you’ve finished treatment, you’ll have regular follow-up appointments with your care team. At these appointments, your doctor will do physical exams and talk with you about any new symptoms or treatment side effects. If you have concerns between appointments, you can make a phone call or send a message through your patient portal. Members of your medical team want to support you in any way possible.
Read on to learn more about how you and your medical team will monitor your breast cancer after treatment.
What is Recurrence?
After treatment for breast cancer, if treatment was given with the intention of curing the disease, people are said to have “no evidence of disease.” The word “remission” does not apply to people in this setting because remission refers to disease that is still present but is no longer seen.
If the cancer later comes back, the cancer is said to have recurred, and the person is said to have had a recurrence.
The cancer may return to the same area as before or come back elsewhere in the body. 1
Why does recurrence happen?
When treating breast cancer, we try to treat all of the cancer cells. Sometimes, some cancer cells that are too small to detect are left behind. These cells may grow and multiply to the point where they cause symptoms and tests can detect them.1-2 All of the treatment given in the curative setting reduces the risk of recurrence, but in some people, the disease is not entirely eliminated.
Fears about recurrence
After breast cancer treatment, many people become hyper-aware of what’s going on with their bodies. You may find yourself more anxious than usual and pay more attention to the physical sensations of your body. You may wonder if any unfamiliar symptoms are a sign that your cancer has come back. This hyper-aware state tends to get better over time.
Feeling concerned about breast cancer recurrence is natural. You may feel like you’re worrying too much, but these feelings are valid and common among many who have been through breast cancer treatment. Talking to others who are going through the same thing can help. If it’s something that you’re interested in, your medical team can help you connect with local or virtual breast cancer support groups.
Fears about recurrence may also come up when you hear about someone else being diagnosed with breast cancer or a recurrence of their cancer. This seems to be particularly the case when a celebrity or other well-known person is diagnosed. New worries may surface if you have a doctor’s visit or an appointment for a mammogram coming up. Other times that people will be more anxious include the anniversary of their diagnosis or if they have symptoms for which they do not have another explanation. During October, Breast Cancer Awareness Month in the United States, encountering repeated reminders of your diagnosis can also make you feel anxious.
Thoughts about breast cancer recurrence can be scary, and you may want to push them away or avoid them. It’s OK to acknowledge how you’re feeling and confide in others. We encourage you to listen to your body and reach out for support when you need it.
Monitoring breast cancer after treatment
After breast cancer treatment, you’ll have regular follow-up appointments with your medical team. The timing of these visits may depend on your situation. You can generally expect a doctor’s visit every few months shortly after finishing treatment.3 If you had radiation therapy as well as chemotherapy and/or hormonal therapy, you may alternate visits between the medical oncologist and the radiation oncologist.
Over time, these visits may become more spread out. After two to three years, you may see your doctor every six months. After five years, you may have a doctor’s visit about once a year. (3-4)
At these follow-up appointments, your doctor may do a physical exam of your breast or chest area to look for any changes. These appointments are also opportunities to ask questions and discuss any new symptoms or side effects of treatment. 5
Mammograms
If you’ve had breast-conserving surgery (lumpectomy), you may get a mammogram of the treated breast around six months to a year after you finish radiation treatment and about once a year after that. You will also have regular mammograms of the untreated breast. 6
If you’ve had a mastectomy of one breast, you won’t need to get mammograms of the treated breast. You will still have regular mammograms of the untreated breast. If you’ve had a double mastectomy, you won’t need mammograms anymore because the surgery removed most of your breast tissue. Your doctor may perform physical exams to check if cancer has returned in the skin or chest wall. You can also perform breast self-exams to
feel for any changes. 6
If you’ve had breast reconstruction surgery using your own tissue, you generally will not need regular mammograms. You can still get a mammogram or breast ultrasound if you or your doctor identify any concerns. 6
Other Exams
If you’re not experiencing symptoms, your follow-up care will most likely consist of mammograms and physical exams. Research has shown that more intensive tests and exams like blood tests and imaging scans (CT scans, PET scans, MRI scans, bone scans) do not improve breast cancer outcomes for people who aren’t experiencing symptoms. If you do experience symptoms or your doctor notices something during a physical exam, then you may have some of these tests done to find out if your cancer has returned. (3,7)
Depending on what kind of breast cancer treatment you received, your doctor may also order some follow-up exams to monitor known side effects of your treatment type.
If you’re taking the drugs tamoxifen or toremifene, you may receive annual pelvic exams. This is because these drugs may increase the risk of uterine cancer, especially for people who have gone through menopause. 3
If you’re taking an aromatase inhibitor or experiencing medically-induced menopause, your doctor may recommend a bone density scan. Aromatase inhibitors and menopause can cause a drop in estrogen levels, leading to bone thinning. 3
When to talk to your doctor
At your follow-up appointments, let your doctor know if you have any new or changing symptoms. Call your doctor or send a message through the patient portal if you have concerns between appointments. You can reach out to your primary care provider or any other medical team member, and they’ll work together to connect you with the right person to hear your concerns. They may decide to order tests or advise you to monitor your symptoms and let them know if anything changes.
Some people may be hesitant to reach out to their medical team because they don’t want to be a bother. We’re here to tell you that you are not a bother. Your well-being is your medical team’s priority, and they want to hear from you if you have any concerns. It can’t hurt to call. A good rule of thumb is if any symptom lasts for five days or more (or worries you for five days or more), contact someone on your care team.
Some breast cancer treatments have side effects that last a long time or may not show up until after treatment ends. Ask your doctor if you’re unsure whether the symptoms you’re experiencing could be side effects of treatment.
Symptoms of recurrence
Over time, you’ll get better and better at knowing what symptoms you should worry about and what you should not. If you have another health condition, you’ll know what kinds of symptoms you might expect from that condition.
We encourage you to listen to your body. Becoming familiar with the consistency of your breasts through breast self-exams can help you identify any changes. You should let your care team know about anything you feel worried about, but some symptoms you should watch for include the following:
- any abnormality in the breasts, such as lumps or bumps
- nipple discharge or flattening
- hardening or thickening of the breast tissue
- red nodules under the skin
- swelling or lumps under the arm 8
These symptoms may be a sign of breast cancer recurrence and can also be normal after surgery or radiation therapy.
You may experience different symptoms depending on the area of the body affected. For example, bone pain or fractures may be a sign that the cancer has spread to the bone.7 However, because bone and joint symptoms are also associated with aging and some breast cancer treatments, experiencing these symptoms does not necessarily mean your cancer has returned. Your medical team can help you find the source of your symptoms.
Confirming recurrence
If you’re experiencing symptoms or your doctor identifies a concern during a physical exam, your doctor may order further tests to determine if your cancer has returned. These may include a blood test, mammogram, ultrasound, MRI, PET scan, CT scan, or biopsy.8 In general, a biopsy should be done to confirm that any abnormality seen on scans is actually cancer. Scans alone cannot tell us that the cancer has recurred with 100% certainty.
If the tests confirm a recurrence, your medical team will work with you to develop a treatment plan. We understand that learning your cancer has returned can be difficult. We want you to know that there are a lot of effective treatments for breast cancer recurrence, and your care team is here to support you.
You may wish to talk with a counselor, psychologist, social worker, or another specialist who can help you care for your mental health during this challenging time.
Summary
After breast cancer treatment, you and your medical team will work together to monitor how you’re feeling. At regular follow-up visits, your doctor will do physical exams and check in with you about your symptoms and any treatment side effects. Depending on your situation, you may also have regular mammograms after treatment.
Don’t hesitate to contact your medical team if you experience any new symptoms or have other concerns. They may advise you to continue to monitor your symptoms or order tests to determine if your cancer has returned.
Many people experience fear or anxiety about the possibility of breast cancer recurrence. This anxiety is normal and tends to get better over time. It may help to talk with a mental health professional or connect with others in breast cancer support groups or online communities.
References
- When cancer returns: How to cope with cancer recurrence. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer/art-20044575. Published November 16, 2021. Accessed January 9, 2023.
- Dealing with cancer that comes back. Cancer.Net. https://www.cancer.net/survivorship/dealing-with-cancer-comes-back. Published June 2, 2022. Accessed January 9, 2023.
- Follow up care after breast cancer treatment. American Cancer Society. https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor/follow-up-care-after-breast-cancer-treatment. Published January 5, 2022. Accessed January 9, 2023.
- Follow-up care for breast cancer patients. UCSF Health. https://www.ucsfhealth.org/education/follow-up-care-for-breast-cancer-patients. Published June 24, 2022. Accessed January 9, 2023.
- Follow-up after treatment. Breast Cancer Now. https://breastcancernow.org/information-support/facing-breast-cancer/going-through-breast-cancer-treatment/follow-after-treatment. Published May 2019. Accessed January 9, 2023.
- Mammograms after breast cancer surgery. American Cancer Society. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/having-a-mammogram-after-youve-had-breast-cancer-surgery. Published January 14, 2022. Accessed January 9, 2023.
- Breast cancer: Follow-up care and monitoring. Cancer.Net. https://www.cancer.net/cancer-types/breast-cancer/follow-care-and-monitoring. Published September 2021. Accessed January 9, 2023.
- Breast cancer recurrence: Symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/8328-breast-cancer-recurrence.
Published March 24, 2021. Accessed January 9, 2023.
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