ST. JOHN HEALTH BREAST CARE PROGRAM
PATIENT GUIDE FOR
FOLLOW-UP CARE FOLLOWING BREAST CANCER THERAPY
As part of your ongoing care within the St. John Health System, the following recommendations are being provided to you as follow-up to the treatment you have received for your breast cancer. The intent of these recommendations is to assure for the close monitoring of your health care status, help you to cope with possible treatment-related side effects, and to help sustain your general overall health.
Follow-up Care Recommendation
Physician visit: You should schedule an appointment with your surgeon or medical oncologist (follow-up physician) every 3-6 months for the first 3 years after your breast cancer surgery.
In years 4 and 5, this appointment should be scheduled every 6 months. At year 5 and each year thereafter, your physician appointment should occur once a year. If you are taking hormone therapy (i.e., tamoxifen or an aromatase inhibitor), your follow-up appointments will be with your medical oncologist who will advise you on when to schedule these visits and other possible evaluations. You should also continue to take the hormone therapy as prescribed by your follow-up physician.
Post-treatment mammogram: Your first mammogram should be done 6 months after completing radiation therapy and thereafter every 6 months for the next 2 years or as recommended by your follow-up physician.
Breast self-examination: You should continue to perform a breast self-examination every month at the same time of the month.
Pelvic examination: You should schedule an annual gynecologic visit with your OB/GYN physician at which time you will have a PAP test. If you should experience any vaginal bleeding (especially if you are taking tamoxifen), you should report this event to both your OB/GYN and follow-up physicians.
Routine follow-up You should continue to be followed by your primary care physician if you have other medical conditions (e.g., high blood pressure, diabetes, arthritis, etc.) for which you are receiving treatment.
Women should also have other screening tests performed based on their age. The following additional health screening guidelines are suggested:
Age 40-49
Cholesterol check every 5 years
Blood sugar every 3 years
Age 50-64
Cholesterol every 5 years
Blood sugar every 3 years
Colonoscopy annually starting at the age of 50
Possible bone density evaluation
Age 65+
Cholesterol every 5 years
Blood sugar every 3 years
Colonoscopy annually starting at the age of 50
Possible bone density evaluation
Your follow-up visits and evaluations will be tailored to your specific needs. The following evaluations will be scheduled as your follow-up physician determines necessary to monitor your health status: Chest X-Ray, CAT scan, bone scan, liver ultrasound, breast MRI, blood tests which will evaluate certain tumor markers and your liver and kidney function, and any other test(s) or evaluation(s) that would be beneficial in the monitoring of your health status.
What to Look Out For
It is important to be aware of changes in your body in between doctor visits. Immediately call your physician if you experience the following symptoms:
• New lumps or nodules in your breast or the skin around your surgery site.
• Bone pain
• Chest pain
• Abdominal pain or swelling
• Shortness of breath or difficulty breathing
• Persistent headaches
• Persistent cough
• Nipple discharge
• New rectal or vaginal bleeding
• New fullness or redness in your breast or arm on the side of surgery
• Back pain
Lifestyle Recommendations
Other lifestyle factors are important in maintaining health and are highly recommended for your well-being:
Regular exercise: The American Cancer Society (ACS) recommends at least 30 minutes of moderate to vigorous activity on 5 or more days a week. Moderate activity means anything that makes you breathe as if you were walking briskly. Vigorous exercise causes the heart rate to increase, deep breathing and sweating.
Weight lifting, yoga and tai chi are beneficial for improving flexibility, balance and strength. Exercise is also valuable to help prevent treatment-related fatigue, improve mood and sleep, and decrease stress.
The most important benefit of exercise is that you may reduce the risk of cancer recurrence by boosting the body’s immune system.
Maintain a healthy weight: Increased tummy fat is a predictor for several diseases including diabetes and cancer. Weight gain after menopause has been associated with a higher risk of breast cancer. It is important that you try to achieve your ideal body weight, which is based on your height and body frame.
Good nutrition: Good healthy eating habits are important for lowering the risks of many diseases including cancer. Incorporating 5-10 servings of fruits and vegetables per day should be the basis for your diet (a serving is ½ cup) --
especially recommended are the dark green leafy and orange vegetables. Blueberries are high in antioxidants which support the healing processes and help to reduce the risk of cancer and infection. Studies suggest that a low-fat diet may be protective against cancer. It will certainly benefit your heart by reducing the fats in your diet.
Women need to make sure they are getting enough calcium in their diet by way of dairy products or supplementation -- especially after menopause. The goal should be 1200 mg per day. Vitamin D plays a very important role on how calcium is absorbed, and some studies show that Vitamin D levels may be low in patients with cancer. Please talk to your physician about a blood test for Vitamin D if you haven’t had one already.
Smoking Cessation: Smoking and second-hand smoke will delay your healing time and has negative effects on the effectiveness of both chemotherapy and radiation therapy. It also increases your risk for developing cancer. Advise family and friends not to smoke around you or when they are in your home or car for your continued recovery and health.
Alcohol: Consuming 2 alcoholic drinks per day increases your risk of breast cancer by one-third so try to limit your intake to 4 ounces per day or less. While wine may have beneficial effects on the heart, you should also keep your intake to an occasional drink.
Stress Management: It is normal to have feelings of anxiety, depression, and stress. Your emotions may trigger new physical problems of fatigue, poor sleep, headaches, body aches and other symptoms. Be sure to secure help and support as needed to handle these feelings and/or symptoms.
The mind-body connection should be part of your daily routine. Surrounding yourself with a community of caring family, friends, church or synagogue is part of the healing team. Journaling, support groups, massage therapy, yoga, and music are good activities to relieve these feelings and can also help to heal your spirit. Make time for fun! Laughter, pets and children can reduce anxiety and improve mood. Laughter really is good medicine!
Please ask for a list of the many on-line resources available to aid you in your healing.
PLEASE DO NOT HESITATE TO MAKE CONTACT WITH YOUR NURSE NAVIGATOR OR FOLLOW-UP WITH YOUR PHYSICIAN IF YOU HAVE ANY QUESTIONS AND/OR CONCERNS OR REQUIRE ADDITIONAL SUPPORT REGARDING YOUR ONGOING CARE WITHIN THE ST. JOHN HEALTH BREAST CARE PROGRAM
