Updated 12 June 2006

The primary goal of follow up is to detect potentially curable, new or recurrent disease. A secondary goal is to assess treatment outcome.

1. All breast patients should be seen for a physical examination at least every 6 months for the first five years and then annually. As well as the affected breast or mastectomy site, the chest wall, regional. The chest wall, regional lymph node drainage areas and the contralateral breast must be examined. The spine should be percussed for bony tenderness, the lungs auscultated and the abdomen examined for hepatomegaly. A mammogram of the contralateral breast should be done annually. Symptoms or signs should be investigated as indicated. Blood work, chest x-rays and bone scans are not recommended in the absence of symptoms or signs.
2. Breast self-examination should be instructed to all women. The postmastectomy chest wall should be examined in a similar manner.
3. If the patient has had breast conservation treatment, careful follow up of the treated breast is required as follows:

• five to six weeks after radiation is completed, the patients should be seen at an Agency or a consultative clinic to assess acute reactions.
• for five years the patient should be seen every six months by a physician. Baseline, post-treatment bilateral mammograms should be performed approximately six months after all treatment has been completed and repeated annually thereafter.
• after five years the patient should be seen every year by their family doctor for physical examination and bilateral mammogram.

Link to follow-up program after breast cancer treatment brochure.

1. A new primary malignancy in the contralateral breast occurs at a rate of approximately 0.5% to 1% per year.
2. Local recurrence in a breast previously treated by partial mastectomy and axillary node dissection with or without radiation therapy (2% per year for 5-6 years, then 1% per year).
3. Local recurrence on the chest wall (and occasionally in the regional nodes) following mastectomy.

The first two of these are most important in that cure rates are potentially high whereas in the third instance long-term control may be possible. (Local recurrence on the chest wall can be an important cause of morbidity and patients should be assessed for treatment despite the poor overall survival prospects.)