Follow up care after treatment for breast cancer (updated 15 July 2003)Regular follow-up examinations are very important after cancer treatment, to detect whether the cancer has returned. The woman should inform her doctor if she has any problems that crop up, such as pain, cough, loss of appetite or weight, dizziness or headaches. The commonest sites of recurrence due to spread of the disease from the original site in the breast, are the bones, lungs and liver. A mammogram of the opposite breast should be done annually or every 2 years once. After breast conservation surgery, mammographic screening to look for a local recurrence is important. Do not forget monthly self breast examination. If conservation surgery (eg lumpectomy) was done, one should ask your doctor and learn what is to be expected and felt as a result of the treatment effect such as thickening and hardening from radiation therapy. Difficult as it might seem in the initial period (because psychologically, one may not have recovered) it should not be neglected. Studies world-wide have shown no survival benefit to routine surveillance of the chest (chest radiograph), liver (ultrasound) and bones (bone scan). Therefore, in most breast clinics, routine scans and blood tests are not done, unless the woman has symptoms that suggest recurrence. Recurrence Rates after Breast Conserving Surgery (eg Lumpectomy, Quadrantectomy or tumorectomy)
In breast conserving surgery (where surgery did not involve removal of the whole breast) even with additional treatment such as radiotherapy, local recurrence of disease occurs in approximately 1-2% of patients per year, rises to 5-10% being reported 5 years after completion of initial treatment and then, falling to 1% per year after 8-10 years. After breast conserving surgery, the patient also has a 6 fold increased lifetime risk of developing a second primary cancer in the contralateral (opposite) breast. True recurrence would be a breast cancer occurring at the same site or same quadrant of the breast as previously. Early detection of recurrence is important in order to optimize treatment for local control as well as to reduce suffering and death (morbidity and mortality). Normally in local recurrence, the whole breast is surgically removed (mastectomy) without compromising survival. Recurrence can be in the skin, breast tissue, nipple or lymph nodes. Therefore, it is very important that annual screening mammograms are performed for women with breast conserving surgery. | 
