After breast cancer treatment

Breast cancer follow-up is long, mostly low-intensity, and centred on imaging of breast tissue plus management of treatment effects. The two things that most affect day-to-day life afterwards are hormone therapy side effects and the physical consequences of surgery and radiotherapy — both of which have far more solutions than people are usually told.

• Annual mammography of remaining breast tissue, generally continuing for many years. After mastectomy without reconstruction, the treated side is examined rather than imaged.
• Clinical review, often annually, sometimes on a patient-initiated pathway with a fast route back in.
• Ongoing prescription and review of hormone therapy, where relevant.
• Bone density (DXA) monitoring on aromatase inhibitors, and heart monitoring after anthracyclines, trastuzumab or chest radiotherapy.
• Routine whole-body scans and tumour markers are not standard follow-up for people without symptoms — this reflects evidence, not cost-cutting.

Tamoxifen, aromatase inhibitors and ovarian suppression meaningfully reduce recurrence risk, and a substantial number of people stop early because of side effects — often without telling anyone. Almost every side effect has an approach.

• Joint and muscle pain: exercise helps; switching between agents is often possible.
• Hot flushes and night sweats: non-hormonal options exist, but some interact with tamoxifen — see menopause after cancer.
• Vaginal dryness and painful sex: moisturisers, lubricants and, in discussion with your team, low-dose vaginal oestrogen.
• Bone thinning on aromatase inhibitors: DXA, calcium and vitamin D, weight-bearing exercise, and bone-protecting medication where indicated.
• Mood and sleep: treatable, and worth raising.

• Report any swelling, heaviness, tightness or a sleeve that suddenly feels snug — early treatment is far more effective. See lymphoedema after cancer treatment.
• Ask for referral to a lymphoedema service rather than waiting for it to declare itself.
• Exercise, including progressive resistance training, is now supported rather than avoided; build up gradually with advice.
• Look after the skin: treat cuts promptly, and seek advice quickly for redness, heat or fever in the affected arm, which can indicate cellulitis.
• Shoulder stiffness and cording after surgery respond well to physiotherapy — ask.

• A new lump or thickening in either breast, the chest wall, armpit or above the collarbone.
• Skin changes: dimpling, redness, rash on the breast or scar, or nipple change.
• Persistent bone pain, particularly in the back, hips or ribs, especially if it wakes you.
• Persistent cough or breathlessness, or unexplained weight loss.
• New arm swelling, or redness and heat in an at-risk arm.