Even after the most complete treatment, there's always a chance that
cancer will recur. Most recurrences happen two or three years after
surgery. The longer you go without a recurrence, the greater are your
chances of remaining free of disease. But you can never say that the
cancer has been completely cured.
Because of this possibility, you need regular follow-up visits with
a healthcare professional. It could be your family physician, your
oncologist, or your breast surgeon. What's important is to have a
single person in charge of the follow-up care. Usually you'll be seen
as often as every few weeks immediately after treatment, and perhaps
only every six months later on. There is no "right" schedule. Eventually,
you will probably be down to a single annual visit.
What does follow-up involve? Most physicians suggest a physical
examination to look for signs of local recurrence—new lumps
within the breast after lumpectomy, ortiny hard nodules in the surgical
scar after mastectomy.
In addition, mammography will be scheduled on a regular basis, and
you may have a number of blood tests that will assess the function
of your liver, bone marrow, and other organs, and a chest X-ray. Other
tests such as CEA (a protein found in the blood of patients with cancer)
and bone scans are not used routinely.
Currently, many experts feel that there is little to be gained by
performing multiple tests on patients that are asymptomatic—that
is patients who have no symptoms.Such tests may detect a recurrence
a few months earlier, but earlier diagnosis will not change the outcome
of whatever treatment you might need.
CBE will be part of your regular check ups. The physician will probably
spend additional time examining the scar and areas where enlarged
lymph nodes may be found—under the arms, and around the collar
Every woman who has had breast cancer should have a mammogram once
a year, regardless of age.
If you had a lumpectomy, the films may be more difficult to interpret,
so make sure that previous mammograms are available for comparison.
If you had a mastectomy, you should have mammograms of the other
breast. If you are sensitive near the post-surgical scar, ask the
technologist for a Mammopad—a soft sheet of special padding
that fits on the mammography device.
For women with especially dense breasts, or women who present unusual
diagnostic challenges, MRI is often an effective although expensive
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Breast Self Examination
One of the key components of follow-up is your monthly breast self-examination,
or BSE. Recently you might have read that BSE is not effective in
saving lives. But many leading experts and patient advocacy groups
remain convinced that women who are well trained in BSE should continue
to examine their own breasts. BSE is particularly important for women
at higher risk of breast cancer—and that includes you and your
first degree relatives.
BSE is not a skill that you can learn from a brochure or a shower
card. The best way to learn it is from your healthcare provider, or
from a good breast self exam video. Check the Library section at the
end of the book to find out how you can get the most up-to-date instructional
videos on BSE.
BSE should include:
Looking: Using a mirror, check the shape and
size of your breasts, and the color and texture of your skin,
first with your arms down, then with your arms in the air. Try
to learn what's normal for you, so that you can spot any changes
Check your breasts in two other positions—pushing
down on the hips, to tighten your chest muscles, and bending
forward at the waist, with your arms relaxed. This will help
you spot dimpling—the tugging on the skin or nipple often
caused by a growing tumor.
Next, lie down with a folded towel under your
shoulder. Extend the arm out at an angle to spread the breast
tissue more evenly. You will need to examine the breast as well
as the area where breast tissue may be found—from the
armpit, to the breast bone, and from the collar bone to the
Use three middle fingers to examine the breast.
Use the pads because they're more sensitive than the tips. Keeping
the fingers straight with the pads flat against the breast,
make three dime-sized circles. One just lightly, one deeper,
one deeper still. This will enable you to check the full thickness
of your breast.
When you move your
hand, don't lift the fingers away from the skin, to avoid missing
a spot. Cover the entire area, spot by spot, going up and down
in strips about as wide as your three fingers.
When you've finished, lower your arm and examine
your armpit for possible lymph node enlargement. Then check
the other breast the same way.
If you had a mastectomy you are not likely to
find a lump within the flap tissue used for reconstruction.
Local recurrences are more likely to appear as tiny firm beads
along the incision line.
If you had a lumpectomy, you will probably feel
irregular lumpiness at the surgical sight shortly after the
lumpectomy heals. You need to become familiar with the new look
and feel of your breasts, so that you can report any changes
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Care of the Surgical Arm
After a mastectomy and particularly if you also had a lymph node dissection,
your arm may feel numb and tingly due to nerve damage during surgery.
Later, you may feel shooting pains due to nerve re-growth. You may
also have decreased range of motion or weakness in the shoulder as
a result of nerve damage or as a result of prolonged disuse. There
is not much that you can do to reverse numbness due to nerve damage.
Some of it may improve as the nerves heal over the years.
Your healthcare professional will tell you which exercises are appropriate
to help your arm regain its mobility and strength. It is very important
to follow the exercise schedule faithfully so you can recover your
full range of motion. You will find a description of some of the exercises
in the mastectomy section of the Surgery Chapter. Once you regain
your full range of motion, you will not need to continue these exercises.
Lymphedema is swelling of the arm due to scarring of the lymph ducts
after surgery or radiation. This condition occurs in approximately
ten to twenty women out of a hundred, sometimes months or years after
It is important that you always follow your medical team's recommendations
about how to avoid injury to the arm to reduce the chances of developing
Precautions that will help protect your arm from lymphedema:
• Avoid sunburns or burns while cooking
• Have all injections, vaccinations, blood samples, and blood
pressure tests done on the other arm whenever possible
• Use an electric razor with a narrow head for underarm shaving
to reduce the risk of nicks or scratches
• Carry heavy packages or handbags on the other arm
• Wash cuts promptly, treat them with antibacterial medication,
and cover them with a sterile bandage; check often for redness,
soreness, or other signs of infection
• Never cut cuticles; use hand cream or lotion instead
• Wear watches or jewelry loosely, if at all, on the operated
• Wear protective gloves when gardening and when using strong
• Use a thimble if you sew
• Avoid harsh chemicals and abrasive compounds
• Use insect repellent to avoid bites and stings
• Avoid tight elastic cuffs on blouses and nightgowns
• If your arm becomes red, swollen, or feels hot, call your
doctor at once.
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