Testing Needed After Initial Breast Cancer Treatment

Uploaded by drjayharness on 08.05.2012

>>> DR. JAY HARNESS: After you have completed all of your initial treatments for breast
cancer, the question then becomes what goes on? What is the routine followup? What things
should be done right away? What I like to share with you is a lovely resource that you
can download and review yourself.
This is called the NCCN Guidelines for Breast Cancer Patients. NCCN stands for The National
Comprehensive Cancer Network. These same guidelines are used by us at our cancer center. This
is an example page a little more complex than what you will see in the lay person’s version
but we used these guidelines that are weekly, multidisciplinary breast conference to make
sure they were in line with these national standards. These national standards are widely
So I would like to share with you what NCCN suggest as part of the routine followup for
patients after they have had their initial treatment.
For the first five years, a patient should be seen every four to six months. Typically
at my place, I see patients twice a year. One of those times is when the annual mammograms
are done. My medical oncologist usually sees the patients three times a year. In the middle
of all these, the radiation oncologist may want to see the patient once or twice.
So during that first five years, the followup is pretty intense. What goes into that followup?
Well, first of all, obviously a physical exam and history. Second of all, yearly mammograms
are absolutely recommended. Thirdly, if a patient is on Tamoxifen and has her uterus,
then a yearly gynecologic examination is recommended because there is a small yet real risk of
increased of uterine cancer.
Women who are on aromatase inhibitors (AIs) should have regular bone scans are done because
one of the side effects of AIs is demineralization, loss of calcium in the bones and this is obviously
suggesting that calcium supplements are needed, things of that sort.
Maintaining on an active lifestyle, healthy way, you have heard me talk about this repeatedly
at breastcanceranswers.com. Now, every now and then I get a question what about CT examinations
or what about Pap CT examinations?
As part of the routine followup of stage I and stage II patients, I think the use of
annual CT examinations is not well-supported. Think about the extra radiation that you are
getting from these exams, so it is not well supported at all.
Once we get into stage III disease or of course stage IV disease, then the situation is different
and monitoring for systemic failure at that level of the initial cancer may be more important.
Interestingly, in the NCCN guidelines, the routine use of CT scan or Pap CT scan is not
recommended unless we know a patient has got a recurrence.
I have also shared with you previously that the followup for breast cancer is a lifetime
journey. If you have an estrogen receptor positive breast cancer, the first five years
is wonderful, but the next five years and the next five years after that are really
important. Yes, it is true we can see cancer come back elsewhere in the body in that second
five-year time period, so you do need to be monitored, need to be seeing your providers
on a regular basis.
So I strongly recommend that you take a look at nccn.com, that you look at these guidelines
for breast cancer patients. Make them part of the data and information that you have,
so that you feel fully empowered.
Hi, I am Dr. Jay Harness and I want to share with you important information that I believe
that every newly diagnosed patient with breast cancer needs to know.
Susan Denver: I am a breast cancer survivor.
Katherine Stockton: I am a breast cancer survivor.
Coree: I am a breast cancer survivor.
Susan Denver: And I want every woman to know…
Katherine Stockton: …about personalized breast cancer treatment…
Susan Denver: …and the Genomic Test.
Coree: A test that helps guide a woman and her doctor…
Katherine Stockton: …to the best treatment options for her.
Susan Denver: Pass it on!