Follow-up care after treatment

When you finish active treatment for breast cancer, you will continue to have regular follow-up to monitor for signs of recurrence. ‘Active treatment’ may include surgery, chemotherapy and radiotherapy.

Your team will recommend a plan for tests and check-ups so they can pick up any changes early.

Who provides follow-up care

Your team will create a follow-up care plan, based on your individual situation. This plan is also called a 'survivorship plan'.

In follow-up care appointments, you can:

• ask questions
• talk about any physical or emotional side effects you are experiencing.

Doctors and nurses can give you advice on reducing the impact of side effects on your life and wellbeing.

The people in your treating team will depend on your needs. You will see your surgeon and radiation oncologist if you have had radiotherapy, and your medical oncologist if you are on endocrine therapy.

You may see your specialist (your medical oncologist or surgeon), your GP or both – often referred to as ‘shared care’.

They may also refer you to a:

• physiotherapist
• lymphoedema therapist
• exercise physiologist
• psychologist.

These allied health professionals can help you manage any ongoing side effects of treatment. Find out about Allied health care for early breast cancer.

You may also need practical and financial help as you recover from treatment.

About shared care with your GP

Your GP and your specialist team may share your follow-up care. Shared care for breast cancer is quite common. Studies show that follow-up by a GP is a safe and effective alternative to follow-up by a specialist. It can also be more convenient, as you may have easier access to your GP than to a specialist.

Your GP can:

• renew prescriptions you received from your hospital-based treating team
• arrange rapid access to your specialist at any time
• provide better continuity of care in the long term.

The follow-up care plan

A basic care plan will usually include:

• a summary of your treatment
• contact details for the health professionals involved in your treatment
• side effects or symptoms to look out for
• any possible long-term side effects that may have been discussed with you
• ways to maintain a healthy lifestyle
• a schedule for follow-up tests, such as:
  • physical examination
  • breast imaging (mammogram and/or ultrasound)
  • checking your menopause status and bone health if you are having hormone-blocking therapy, such as tamoxifen or an aromatase inhibitor.

Example of a follow-up care schedule

Years 1 and 2

Medical history and physical examination: Every 3 to 6 months

Imaging (mammogram and sometimes ultrasound): Every 3 to 6 months

Years 3 and 4

Medical history and physical examination: Every 6 to 12 months

Imaging (mammogram and sometimes ultrasound): Every 6 to 12 months

After 5 years

Medical history and physical examination: Every 12 months

Imaging (mammogram and sometimes ultrasound): Every 12 months 

Usually, you'll see different members of your team (medical oncologist, surgeon, radiation oncologist) once a year. These appointments are spaced out, so you see someone once every 4 to 6 months. Often after a couple of years you won't need to see your radiation oncologist anymore. At this point, your visits with the surgeon and medical oncologist may stretch out to every 6 months. 

Sometimes the team will recommend you see your GP for regular review - this is called 'shared care'.

Tests and scans after active treatment

You usually won’t need chest X-ray, bone scan, CT scan, MRI scan, PET scan, blood count and tumour markers. These are not done, unless your doctor wants to look at specific symptoms. Research has shown that regular CT scans or PET scans looking for recurrent disease does not improve outcomes.

Five years after treatment, you can return to BreastScreen Australia for your annual mammograms if you wish and if your doctor is happy with that.

Anxiety around tests and appointments

Some people find check-ups and tests reassuring. Others feel anxious around the time of their appointments. Both reactions are normal. Talk to your doctors if you feel anxious and need support around the time of follow-up tests.

Our Online Network is a safe and supportive community to connect with others who have experienced this.

Why follow-up appointments are important

People with a breast cancer diagnosis have a higher risk of developing breast cancer in the other breast than the general population. Unfortunately, a small number of people will go on to develop metastatic breast cancer, where the breast cancer spreads to other parts of the body.

What to do between check-ups

It's a good idea to get to know how your breasts or chest look and feel after your treatment. After surgery, swelling and scarring usually settles down in a few months but it can take many months. After radiotherapy, changes in the breast sometimes take up to 2 years to settle. 

Don’t wait for your next appointment. Contact your GP or someone from your treating team as soon as possible if:

• you notice any breast changes
• you experience other symptoms that concern you
• something just doesn’t feel quite right.

Tips to prepare for follow-up appointments

The days and weeks before follow-up appointments can be stressful. Some people feel very anxious and refer to it as ‘check-up stress’. We have some tips to manage your anxiety and make the most of your appointments:

• Plan something exciting to look forward to after your check-up
• Write down your questions and concerns before your appointment.
• If you have a lot of questions, ask for a longer appointment when you book. Ask your most important questions first so you get answers for them.
• Think about taking a family member or close friend to your appointment. They can give you emotional support, help ask questions or take notes.
• Ask your doctor if you can make an audio recording of your appointments, to help you to remember what you discussed.
• Practise mindfulness, yoga or use other tools you have used previously to manage your anxiety.

Concern about cancer recurrence

Some people feel they should have more tests and scans as part of their follow-up care. However, research shows that more tests does not improve the length or quality of life of people treated for breast cancer.

In this video - Ongoing care - are extensive body scans needed to detect possible recurrence? - , Professor Mann talks about the natural concerns people have. He explains why extensive testing does not improve survival outcomes or quality of life in people with no signs of breast cancer recurrence.