Follow Up

The Follow-up Clinic

Breast cancer patients are usually advised to attend regular follow-up clinics for at least five years. The purposes of
the follow-up clinic are listed below:

    • To provide reassurance for patients who may be concerned about their cancer returning or spreading.
    • To allow early detection and treatment of any cancer recurrence. Only around 1 in 10 patients will see their cancer recur during the follow-up period. The chance of recurrence depends upon the nature of the original cancer and whether it was treated by removal of the tumour lump only, or by removal of the whole breast. Recurrence is most likely in the first two years of follow-up and is usually detected by mammogram.
    • To detect any new breast cancer in the other breast. The risk of developing a second breast cancer is six times higher in breast cancer patients than in women with no previous history of the disease. However, new cancers are usually suitable for lumpectomy.

  • To detect any cancer spread to other parts of the body (metastases) and to treat them accordingly.

 

What Happens in the Follow-up Clinic?

Patients are usually interviewed by their breast specialist and asked about any new symptoms. The doctor will examine both breasts and armpits. Other parts of the body, such as the abdomen (the stomach area) may also be examined. If a breast lump is discovered then the appropriate tests, such as needle biopsy and mammography, will be performed. All patients who have had curative surgery for breast cancer should have regular mammograms every year as this is the best way of discovering recurrent or new breast cancer. Other investigations, such as PET-CT scan, bone scan, liver scan and blood tests, are not usually required if the patient is well and if nothing is found on examination. Such investigations can raise the false possibility of cancer spread when it has not actually occurred and expose the patient unnecessarily to harmful radiation.

The normal interval between follow-up visits is 6 or 12 months, but initially the visits tend to be more frequent. The patient may attend two follow-up clinics: one will be a surgical clinic, and the other will be for the planning of any additional treatments such as radiotherapy or chemotherapy, and is called a clinical or medical oncology clinic. In some centres the two clinics (surgical and medical) are combined into one. Monitoring certain proteins in the blood stream known as tumour markers (e.g. CA15-3) is not recommended in patients with early breast cancer who have no symptoms suspicious of breast cancer spread.

Familial Breast Cancer

Up to 10% of all breast cancers are inherited owing to faulty genes. Several genes have been linked to breast cancer, including the BRCA-1 and BRCA-2 and PALB2 genes. Many women with a family history of breast cancer are understandably very anxious and seek medical advice. Some breast cancer units have Family History Clinics to deal with such cases.

Family History Clinic

The patient is interviewed by a breast specialist and asked several questions to assess the breast cancer risk, including a detailed family history of breast and ovarian cancer. After the patient has been examined, her risk of developing breast cancer can be assessed (Table below).

Low-risk Medium-risk High-risk
The chance of breast cancer is increased
2–3 times
The chance of breast cancer is increased
3–5 times
The chance of breast cancer is increased
5–9 times

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