Breast cancer treatment and followup care can be overwhelming. Each individual will need to develop her own strategy for addressing the difficult decisions that lie ahead and living with the long-term uncertainty of her situation. In addition, there may be the need to adjust to the effects of treatment, which can be temporary—such as hair loss during chemotherapy—or permanent, such as the loss of a breast. Other adjustments may include using a prosthesis to replace a missing breast; coping with the side effects of long-term hormonal therapy or other medications; and dealing with fears of a recurrence as well as changes in the emotional landscape surrounding physical intimacy and sexuality.
Most people find it encouraging and helpful to discuss their situation with other breast cancer survivors, clergy, or a counselor. Your friends and family can provide an important support network for the months ahead—keep them close. By all accounts, individuals who have experienced breast cancer should adopt a lifestyle that lessens, to the extent possible, the risk of a recurrence. Make your well-being a priority. Eating well, managing stress, and staying active are the fundamentals to promote your overall health and help you survive your cancer.
This section includes information on:
- When to see your doctor for follow-up exams
- Managing lymphedema
- Using a prosthesis
- Sexual intimacy after treatment
People who have had breast cancer need regular followup examinations in the years after their treatment. The exact schedule will depend on individual circumstances. Initially, routine care typically involves visiting your doctor every three to six months for a physical exam. During your exam, your doctor will check for any signs of recurrence. If you've had a lumpectomy, the exam will include an annual mammography. If the treatment includes mastectomy, the exam will include an evaluation of the chest wall and the unaffected breast and annual mammography of the unaffected breast. If you are taking tamoxifen and have not had a hysterectomy, you will need a yearly Pap test and pelvic examination because of the small risk of uterine cancer associated with this drug. Regardless of the course of treatment, this general schedule should continue for at least five years after treatment and then yearly thereafter.
Nothing can guarantee that your breast cancer will not return. Thus it is important to be aware of the signs and symptoms of recurrent breast cancer. Check your breast, skin, and chest wall monthly for any changes such as new lumps or new areas of thickening around the scar. If you experience any of the signs and symptoms of a recurrence, contact your healthcare provider immediately. If you have new symptoms, your doctor will recommend the necessary tests to determine whether they are associated with a cancer recurrence.
Signs and symptoms of a local recurrence within the breast can include:
- New pulling back of the skin at the lumpectomy site
- One or more painless nodules in the area of the chest wall
- Thickening along or near the mastectomy scar
Signs and symptoms of a regional recurrence can include:
- Lump or swelling in the lymph nodes under the arm, in the groove above the collar or around the breast bone
- Swelling of the arm
- Persistent pain in the arm and hand
- Difficulty swallowing
A recurrence of metastatic cancer can include a wide range of signs and symptoms such as bone pain, persistent dry cough, difficulty breathing, chest pain, loss of appetite, abdominal tenderness or discomfort, persistent nausea, vomiting or weight loss, jaundice, severe headache, visual disturbance, and seizures, numbness or imbalance.
A breast cancer patient who has had lymph nodes removed from her armpit is at risk for lymphedema, the excessive accumulation of lymphatic fluid as a result of the absence of the nodes that help control its drainage. A woman has 35 to 40 nodes in each armpit; the greater the number of nodes surgically removed (especially if the number is more than seven), the more difficult it may be for lymphatic fluid to drain adequately.
The swelling that signals lymphedema is likely to start slowly. A slight puffiness is a sign that you should drink lots of water and pay close attention to the swelling. If it worsens, or if there is a sign of infection—the arm is red or warm to the touch and you are running a fever—contact your doctor. A physical therapist certified in lymphedema management may be able to reverse the swelling. A cancer doctor, breast cancer support group, or breast cancer center may be able to recommend names.
Some steps a patient can take to reduce the likelihood of lymphedema:
- Avoid having your blood pressure taken on, or blood drawn from, the arm at risk. If you've had lymph nodes removed from both arms, you can offer your foot for blood draws and leg for blood pressure, or at least alternate arms.
- Good muscle tone helps the normal flow of the lymphatic system, so follow the exercise program prescribed by your healthcare provider. It's OK to lift weights. Just start at a low weight and work your way up to heavier weights.
- Make as much use as possible of the affected arm for ordinary purposes such as brushing the hair, washing the face, and the like.
- Drink six to eight glasses of water a day.
- Make every effort to prevent the arm and hand from becoming infected. This requires careful attention to cleanliness, scrupulous care of any cuts or bruises, daily use of skin creams to prevent dryness or chapping, and use of garments such as gloves and long sleeves to protect against injuries while gardening or doing chores.
- Guard against burning the skin, whether from kitchen injuries, hot showers or baths, or the sun. Use sunblock providing a sun protection factor (SPF) of at least 15.
- Wear loose-fitting garments and jewelry, especially when traveling by air.
- Avoid lifting objects heavier than you're used to.
- Don't carry a shoulder bag or grocery bag with the at-risk arm.
- When flying, walk about the cabin at least hourly to aid circulation.
Women who opt out of reconstructive surgery after mastectomy often use a prosthesis in place of the missing breast. The silicone-filled breast form comes in a variety of shapes, sizes, and degrees of firmness. A pre-made breast form can start as low as $75; a custom-made prosthesis, which can be made to match your remaining breast, could cost up to $3,000. The higher-priced models generally have a more normal feel and more comfortable fit.
A Perma-Form bra, equipped with one or two built-in foam prostheses, is another option. While a silicone prosthesis looks and feels more natural, a Perma-Form bra is cooler on hot days. You should not attempt to purchase a prosthesis prior to surgery. Many hospitals will send a mastectomy patient home with a "puff," a small, breast-shaped pillow that can be slipped inside an undershirt. This can be used until you have healed from the surgery and are ready to shop for a prosthesis.
Many women fear that the physical changes caused by breast surgery, not to mention the toll taken by chemotherapy and radiation, will have an impact on their intimate relationship with their partner. If your partner seems tentative after your surgery, you might take his or her hand and show where it's OK to touch and where your chest may feel tender. During the months of chemotherapy, intimacy is possible, but at times a patient may be too physically exhausted to think about sex. In addition, chemotherapy can cause vaginal dryness; vaginal lubricants can help. It's best for both members of a couple to communicate their needs and their fears.
[Read more on Cancer and Sexuality.]
Last reviewed on 3/28/10
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