Long-term side effects of breast cancer treatment

When active treatment (surgery, chemotherapy and/or radiotherapy) for early breast cancer is over, some people have few or no ongoing health problems. For others, physical and emotional challenges may continue.

The causes of ongoing problems may be:

• long-term impact of the breast cancer treatment
• ‘late’ side effects that start months or years after treatment.

After you finish active treatment, your doctor will recommend a plan for follow up care. This includes check-ups, tests and discussion of any ongoing side effects.

Common long-term side effects

Below are the most common long-term side effects of breast cancer treatment. You may have none, some, or many of these. You may also have other side effects that are not listed here.

• anxiety
• bone density loss (‘osteoporosis’)
• depression
• fertility issues
• fatigue and tiredness
• joint pain
• lymphoedema
• memory and concentration problems
• menopausal symptoms
• sleep problems
• pain
• peripheral neuropathy
• sexual health and wellbeing changes
• weight changes

Rare late side effects of treatment

Some side effects can develop months or years after treatment for breast cancer. These are called late side effects.

The risk of developing late side effects depends on many factors including:

• your age at diagnosis
• other illnesses or physical conditions you have
• the type, doses and duration of your treatments.

Your treating team can assess and explain long and late side effects. They may need to refer you to other specialists for the treatment you need.

Many of these late side effects are rare. If they do occur, it doesn't mean that your health care team did anything wrong. In most cases, the side effects could not be avoided.

Heart problems

Some breast cancer treatments can cause heart problems. These may be short term or can continue after treatment has finished.

Your team will monitor you carefully, especially if you already have a heart condition.

Read about Heart problems after breast cancer treatment.

Lung problems after radiotherapy

Some late effects can develop after the end of radiotherapy. It is important to know that improvements with treatments have made many of these side effects much less common.

Read about Rare side effects of radiotherapy.

Liver problems

A fatty liver (extra fat in the liver) can develop after years of Tamoxifen treatment. Rarely, this can progress to more serious liver issues such as fatty liver with inflammation ('steatohepatitis') or scarring of the liver ('cirrhosis').

Often there are no symptoms, or you may notice:

• upper abdominal pain
• weight loss
• poor appetite.

Your doctor will order regular blood tests to check that your liver is functioning normally. Ways to help treat a fatty liver are:

• a good diet
• less alcohol
• regular exercise
• giving up smoking.

Developing another type of cancer

Radiotherapy and chemotherapy can increase the risk of developing another cancer in the future, but this is very rare.
Your specialist can talk to you about the benefits of treating your breast cancer compared to the risks of rare side effects.
Endometrial and uterine cancers are rare cancers that can develop in women taking Tamoxifen. However, if you are advised to take Tamoxifen, the benefit is considered to outweigh the risk.

Eye problems

Some medications can cause eye problems:

• aromatase inhibitors such as letrozole
• hormone-blocking medication such as tamoxifen.

Problems are uncommon but you should contact your doctor if you have any changes to your vision or eye problems. They may need to refer you to an eye specialist for assessment and treatment.

Read more about Eye problems related to breast cancer treatment.

Reduce your risk of long-term side effects

After you finish treatment for early breast cancer, it is important to:

• Lead a life that is as healthy as possible. This includes healthy eating, regular exercise and losing weight if you are overweight.
• Stop smoking, if you are a smoker. Smoking increases your risk of many cancers, including recurrence of breast cancer. Giving up can be very hard but resources are available, such as Quitline and the Australian Government’s information on How to quit smoking and vaping.
• Attend your regular check-ups with either your GP or a member of your cancer treatment team. You can discuss any problems and they can investigate anything of concern.
• If you have any unusual symptoms or concerns between check-ups, make an appointment for a medical assessment.