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Breast Cancer MonitoringAka: Breast Cancer Survivor

Protocol
1. Physical Exam
  1. Initially perform every 6 months for 5 years
  2. Later, perform exam yearly
  3. Observe for recurrent or new cancers
    1. Unintentional Weight Loss
    2. Persistent cough
    3. Clinical Breast Exam
      1. Breast or chest wall changes
      2. Lymphadenopathy
    4. Pelvic exam for Ovarian Cancer
    5. Rectal exam for rectal cancers
    6. Stool Occult Blood for Colon Cancer
  4. Observe for other complications
    1. Lymphedema
    2. Premature Ovarian Failure
    3. Osteoporosis
    4. Major Depression
    5. Cognitive decline
2. Labs (no longer routinely recommended)
  1. Lab/XRay surveillance not indicated if asymptomatic
    1. Do not reliably identify metastases
    2. Does not improve survival
  2. Prior protocol
    1. Complete Blood Count every 6 months for 3 years
    2. Chemistry Panel every 6 months for first 3 years
    3. Start annual Liver Function Tests after 5 years
Other monitoring
1. Self Breast Exam: Monthly
2. Mammogram: Yearly
3. Pelvic Examination: Yearly
4. Colonoscopy per routine screening guidelines
Monitoring studies not recommended
1. Routine lab tests are not recommended
2. Routine Tumor Marker labs are not recommended
3. Routine Chest X-Rays are not recommended
4. Routine bone scan are not recommended
Special topics in Breast Cancer survivors
1. New Breast Masses
  1. Evaluate with ultrasound
  2. Mammogram not helpful after reconstruction
2. Lymphedema (10-25%)
  1. Compression with gloves or sleeves
  2. Physical therapy
3. Vasomotor Symptoms of Menopause
  1. Vaginal Estrogen is probably safe
4. Osteoporosis (due to Chemotherapy)
  1. See Osteoporosis Management
References
1. Burstein (2000) N Engl J Med 343:10
2. Sunga (2005) Am Fam Physician 71:699

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.