October 2006

To help doctors give their patients the best possible care, ASCO asks its medical experts to develop recommendations for specific areas of cancer care. ASCO recently updated a clinical practice guideline about follow-up care for breast cancer. This patient guide is based on ASCO's recommendations.

As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your or your doctors' judgment. The final decisions you and your doctors make will be based on your individual circumstances.

In 1999, ASCO published a clinical practice guideline for follow-up care for breast cancer. This guideline was updated in 2006 to reflect developments in the follow-up care for people with breast cancer.

Information in ASCO's patient education materials is not intended as medical advice or as a substitute for the treating doctor's own professional judgment; nor does it imply ASCO endorsement of any product, service, or company.

The purpose of follow-up care for breast cancer is to help maintain good health after treatment, which includes coping with the side effects of treatment, reducing the risk of recurrence (return of the cancer), and watching for signs of recurrence. ASCO's recommendations for breast cancer follow-up care are listed below.

Table. Recommendations for Follow-Up Care for Breast Cancer

Most breast cancer recurrences are discovered by patients between doctor visits. Tell your doctor if you experience the following symptoms:

• New lumps in the breast
  
  
• Bone pain
  
  
• Chest pain
  
  
• Abdominal pain
  
  
• Shortness of breath or difficulty breathing
  
  
• Persistent headaches
  
  
• Persistent coughing
  
  
• Rash on breast
  
  
• Nipple discharge (liquid coming from the nipple)

The following tests are not currently recommended by ASCO for regular follow-up care because they have not been shown to lengthen the life of a person with breast cancer:

• A complete blood count (CBC) test and liver and kidney function tests
  
  
• Chest x-ray
  
  
• Bone scan
  
  
• Liver ultrasound
  
  
• Computed tomography (CT or CAT) scan
  
  
• Fluorodeoxyglucose-positron-emission tomography (FDG-PET) scan
  
  
• Breast magnetic resonance imaging (MRI) test
  
  
• Breast cancer tumor markers, such as CA 15-3, CA 27.29, and carcinoembryonic antigen (CEA)

The recommendations for follow-up care for breast cancer include regular physical examinations, mammograms, and breast self-examinations. The follow-up care may be provided by your oncologist or primary care doctor, as long as your primary care doctor has communicated with your oncologist about appropriate follow-up care. In addition, patients with a possible or known family history of breast cancer should be referred to a genetic counselor. Use these guidelines to talk with your doctor about an appropriate follow-up care plan for you.

To learn more about follow-up care for breast cancer, consider asking your doctor the following questions:

• What follow-up care plan would you recommend for me?
  
  
• What is the risk that the cancer will recur?
  
  
• Based on my personal and family medical history, do I need a referral to a genetic counselor?
  
  
• Where can I find more information about follow-up care?

For women receiving hormone therapy:

• Are there any additional symptoms I should watch for?
  
  
• What side effects are common with this treatment?
  
  
• How often should I schedule additional follow-up visits with the oncologist?

Read the entire clinical practice guideline published in the November 1, 2006 Journal of Clinical Oncology (JCO).

Cancer.Net Guide to Breast Cancer

Cancer.Net (www.cancer.net) is the comprehensive, oncologist-approved cancer information website from ASCO. Visit Cancer.Net to find guides on more than 120 types of cancer and cancer-related syndromes, clinical trials information, coping resources, information on managing side effects, a live online chat series, medical illustrations, cancer information in Spanish, the latest cancer news, and much more. For more information about ASCO's patient information resources, call toll free 888-651-3038.

American Cancer Society
1599 Clifton Rd., NE
Atlanta, GA  30329-4251
Toll Free: 800-ACS-2345 (800-227-2345)
TTY: 866-288-4327
Phone: 404-320-3333
www.cancer.org

Breast Cancer Network of Strength
212 W Van Buren, Ste. 1000
Chicago, IL  60607
Toll Free: 800-221-2141 (English)
Toll Free: 800-986-9505 (Spanish)
Phone: 312-986-8338
www.networkofstrength.org

Breastcancer.org
111 Forrest Ave., #112
Narberth, PA  19702
www.breastcancer.org

CancerCare
275 Seventh Ave.
New York, NY  10001
Toll Free: 800-813-HOPE (800-813-4673)
Phone: 212-712-8400
www.cancercare.org

HER2 Support Group
6973 Mimosa Dr.
Carlsbad, CA  92009
Phone: 760-602-9178
www.her2support.org

Living Beyond Breast Cancer
10 E Athens Ave., Ste. 204
Ardmore, PA  19003
Toll Free: 888-753-LBBC (888-753-5222)
Phone: 610-645-4567
www.lbbc.org

National Cancer Institute
Public Inquiries Office
Building 31, Rm. 10A31
31 Center Dr., MSC 2580
Bethesda, MD  20892-2580
Toll Free: 800-4-CANCER (800-422-6237)
TTY: 800-332-8615
Phone: 301-435-3848
www.cancer.gov

Nueva Vida, Inc.
2000 P St., NW, Ste. 740
Washington, DC  20036
Phone: 202-223-9100
www.nueva-vida.org

Sisters Network, Inc.
8787 Woodway Dr., Ste. 4206
Houston, TX  77063
Toll Free: 866-781-1808
Phone: 713-781-0255
www.sistersnetworkinc.org

The Susan G. Komen Breast Cancer Foundation
5005 LBJ Freeway, Ste. 250
Dallas, TX  75244
Toll Free: 800-IM-AWARE (800-462-9273)
Phone: 972-855-1600
www.komen.org

Young Survival Coalition
61 Broadway, Ste. 2235
New York, NY  10006
Phone: 646-257-3000
www.youngsurvival.org

The American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians of all oncology subspecialties who care for people with cancer. ASCO's more than 20,000 members from the United States and abroad set the standard for patient care and lead the efforts to discover more effective cancer treatments, increase funding for clinical and translational research, and, ultimately, improve cancer care for the estimated 10 million people diagnosed with cancer worldwide each year. ASCO publishes the Journal of Clinical Oncology (JCO), the preeminent, peer-reviewed, medical journal on clinical cancer research, and produces Cancer.Net (www.cancer.net), a comprehensive consumer website providing oncologist-vetted cancer information to help patients and families make informed health-care decisions.

© 2006 American Society of Clinical Oncology. For permissions information, contact permissions@asco.org.