Approach to the patient following treatment for breast cancer

MRI: magnetic resonance imaging; TRAM: transverse rectus abdominis myocutaneous.
* We suggest that patients be seen every three to six months during the first three years after primary therapy, every 6 to 12 months for the next two years, and then annually.
¶ In particular, history should include changes in family cancer history. Thorough examination should be performed of the affected breast (if preserved) or chest wall, the contralateral side, the bilateral axillary regions, and the supraclavicular fossas. For those patients who underwent breast-conserving treatment, providers should be comfortable examining the previously irradiated breast. Regular gynecologic follow-up is recommended for all women.
Δ Refer to UpToDate topic on genetic counseling and testing for those at risk of hereditary breast or ovarian cancer.
◊ Observational data suggest that exercise, avoidance of obesity, and minimization of alcohol intake are associated with a decreased risk of breast cancer recurrence and death in survivors.
§ Bone density evaluation may also be indicated for women 60 to 64 years if additional risk factors exist (eg, a family history of osteoporosis, body weight <70 kg, a history of a nontraumatic fracture, smoking, a sedentary lifestyle, alcohol use, etc).
¥ Breast MRI is not routinely recommended for breast cancer survivors. However, breast MRI can be useful for patients suspected of a breast cancer recurrence when mammography (with or without breast ultrasound) is inconclusive. Furthermore, women with lifetime cancer risk exceeding 20% should be offered supplemental annual screening with MRI. Refer to UpToDate topics on screening high-risk women for breast cancer.
‡ Women treated with breast-conserving therapy should have their first post-treatment mammogram no earlier than six months after definitive radiation therapy. Subsequent mammograms should be obtained every 6 to 12 months for surveillance of abnormalities. Mammography should be performed yearly if stability of mammographic findings is achieved after completion of locoregional therapy.
† Although our approach is to perform imaging on a reconstructed breast only if physical exam findings are present, some institutions image TRAM-reconstructed breasts using mammography since even after mastectomy, some normal tissue may be left on the chest wall from which a new breast cancer may occasionally arise.