Josephine took her last dose of radiation therapy, got dressed, and walked down the hallway. The staff and other cancer survivors were waiting for her. She strode towards them, feeling like a Cheshire Cat with a smile a mile wide. She enjoyed every step. She enjoyed every congratulation. She enjoyed every good cheer. She grabbed the hammer and rung the bell. She was done. Her journey to beat breast cancer was complete.
Fighting breast cancer takes a lot of energy and determination. Many days just wipe you out and some days you just cry. At the end of the journey, the air is fresh, the sky is blue and the sun is brighter than it ever was.
As Josephine walked out the front door, she wondered was next? First, you take a deep breath and inhale the breath of life. Then you put yourself back together. You take moonlight walks with your husband, holding hands and sharing stories. You help your kids with their homework or take your grandkids out for ice cream. You continue to meet with your cancer buddies, attending support groups, helping other women through their battles and making new friends, who are just beginning their journey.
And you take your aromatase inhibitor, that anti-estrogen pill that kills breast cancer. And you remember to take your cancer killing pill each and every day.
You will constantly worry about a recurrence. We all do. Will seeing your doctor prevent a recurrence? Perhaps. When your doctor, when your oncologist says there is no cancer, you will breathe a sigh of relief and feel warm and fuzzy inside.
How often should you see your oncologist? How often should you get a mammogram? How often should get a Breast MRI? Do you need blood work? Do you need CT Scans? Do you need a PET Scan?
The American Society of Clinical Oncology (ASCO) has guidelines to help you through this post treatment journey. You should see your oncologist every 3 months for the first three years, then every 6 months for years 4 and 5 and then once a year after year 5. Your oncologist will ask you questions about your health, listening for symptoms that might suggest a recurrence, so it is very important to be open and honest with your oncologist. Your oncologist will examine you, searching carefully and thoroughly for evidence of recurrence. Your oncologist will pay particular attention to your mammograms and correlate the findings of your mammogram with the physical examination of your breasts and axillae (armpits).
There is a benefit to having a yearly mammogram but not more often. No benefit to screening with Breast MRI has been demonstrated unless you have a genetic mutation, in which case annual Breast MRI is indicated. But no study has demonstrated a lack of benefit, either, so you and your oncologist should decide if Breast MRI is right for you. If you had a mastectomy and either have no breast or a breast reconstructed with an implant, there is no benefit to mammography nor MRI. However, ultrasound of your chest wall can be helpful. Ultrasound technology is an extension of my fingers and as such, ultrasound can identify more suspicious nodules or lumps than my fingers alone. So, although ASCO does not recommend an ultrasound of the chest wall after breast removal, the medical journals suggest that ultrasound of the chest wall may be beneficial.
Of course, any suspicious findings by you or your oncologist should be further evaluated with imaging studies.
In short, see your oncologist twice a year and have a mammogram every year. Do not ask for blood work, CT Scans or PET Scans, as these studies will cost you lots of money and have a very low chance of finding treatable cancer. However, if your oncologist recommends a study, then have the study, as your oncologist will have a good reason for ordering the study. The whole idea of chemotherapy and the anti-estrogen pills is to kill the cancers you cannot see. Your best bet is to take the therapies your oncologist has recommended and kill the cancer early, before it becomes noticeable.
Josephine was happy. She felt confident that she did everything she could to kill her cancer. She sees her oncologist every three months and gets a mammogram every year. She does a self-examination every month and she takes her cancer killing pill every morning.
Do what Josephine does: go through your treatments, see your oncologist and get your mammogram every year!