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Approach to the patient following treatment for breast cancer

INTRODUCTION

According to statistics from the International Agency for Research on Cancer (IARC), there are approximately 29 million cancer survivors worldwide as of 2008 [1]. In the United States, there are an estimated 14 million cancer survivors as of 2014, a figure that is expected to increase to approximately 18 million in the next 10 years [2]. Over three million women have a history of breast cancer, which constitutes 41 percent of the population of female cancer survivors [2]. Although the vast majority of breast cancer survivors are women, approximately 2000 men are diagnosed with breast cancer annually in the United States alone, and most will achieve long-term disease-free survival [3]. (See "Breast cancer in men".)

Patients who are living for decades beyond cancer experience the normal issues of aging, which are often compounded by the long-term effects of having had cancer and cancer therapy. These patients are at risk for a breast cancer recurrence (which is most common in the first five years but may occur even decades following treatment), a new primary breast cancer, other cancers, and short-term and long-term adverse effects of treatment. Additional issues for cancer survivors relate to psychological, genetic, reproductive, social, and employment concerns.

Unfortunately, there is a lack of clear evidence for what constitutes best practices in caring for patients with a history of cancer, and this contributes to wide variation in care [4]. Recommendations for posttreatment surveillance after primary therapy of breast cancer will be reviewed here. A detailed discussion of the patterns of relapse (ie, locoregional recurrence, second primary breast tumor, metastatic disease) and long-term complications of breast cancer therapy are presented separately. (See "Patterns of relapse and long-term complications of therapy in breast cancer survivors".)

A general overview of cancer survivorship is covered separately. (See "Overview of cancer survivorship care for primary care and oncology providers".)

DEFINING A CANCER SURVIVOR

There are many definitions and phases of cancer survivorship. We define a cancer survivor as any person with cancer, starting from the moment of diagnosis. This is consistent with definitions from the National Coalition for Cancer Survivorship [5] and the National Cancer Institute [6].

                               

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Literature review current through: Jul 2014. | This topic last updated: Jun 15, 2014.
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