Follow-up care in breast cancer

Improved early diagnosis and treatment of breast cancer has resulted in a significant decrease in breast cancer-related mortality in many countries. Breast cancer survivors live longer. As a consequence, the prevalence of breast cancer survivors will rise and will put an increasing burden on follow-up oncology clinics. Follow-up of breast cancer patients should be aimed at the detection of curable disease and must comply with the needs of the patient. Regular physical examination may be useful for timely discovery of locoregional relapse, and screening mammography for the early detection of a second primary breast cancer or breast relapse after breast-conserving therapy. Onerous searching for distant metastases by routine investigations will not improve life expectancy of the patient and may even be harmful because of false-positive findings and false expectations and reassurance. Patients seek emotional support, information, physical and cosmetic recovery and prompt access to the oncologist in case of worrying complaints, signs or symptoms. Support, information and screening for relatively healthy patients can be provided by breast care nurse practitioners or family practitioners. For more complex issues, such as debilitating functional treatment regimens, estrogen deprivation symptoms, pregnancy after breast cancer or symptoms suspicious for a relapse, an experienced oncologist should be at hand.