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Follow-up Clinic

The Follow-up Clinic

Breast cancer patients are usually advised to attend regular follow-up clinics for at least five years. The purposes of the follow-up clinic are listed below:

  • To provide reassurance for patients who may be concerned about their cancer returning or spreading.
  • To allow early detection and treatment of any cancer recurrence. Only around 1 in 10 patients will see their cancer recur during the follow-up period. The chance of recurrence depends upon the nature of the original cancer and whether it was treated by removal of the tumour lump only, or by removal of the whole breast. Recurrence is most likely in the first two years of follow-up and is usually detected by mammogram.
  • To detect any new breast cancer in the other breast. The risk of developing a second breast cancer is six times higher in breast cancer patients than in women with no previous history of the disease. However, new cancers are usually suitable for lumpectomy.
  • To detect any cancer spread to other parts of the body (metastases) and to treat them accordingly.

What Happens in the Follow-up Clinic?

Patients are usually interviewed by their breast specialist and asked about any new symptoms. The doctor will examine both breasts and armpits. Other parts of the body, such as the abdomen (the stomach area) may also be examined. If a breast lump is discovered then the appropriate tests, such as needle biopsy and mammography, will be performed. All patients who have had curative surgery for breast cancer should have regular mammograms every year as this is the best way of discovering recurrent or new breast cancer. Other investigations, such as bone scan, liver scan and blood tests, are not usually required if the patient is well and if nothing is found on examination. Such investigations can raise the false possibility of cancer spread when it has not actually occurred.

The normal interval between follow-up visits is 6 or 12 months, but initially the visits tend to be more frequent. The patient may attend two follow-up clinics: one will be a surgical clinic, and the other will be for the planning of any additional treatments such as radiotherapy or chemotherapy, and is called a medical oncology clinic. In some centres the two clinics (surgical and medical) are combined into one.

Familial Breast Cancer

Up to 10% of all breast cancers are inherited owing to faulty genes. Several genes have been linked to breast cancer, including the BRCA-1 and BRCA-2 genes. Many women with a family history of breast cancer are understandably very anxious and seek medical advice.

Family History Clinic

The patient is interviewed by a breast specialist and asked several questions to assess the breast cancer risk, including a detailed family history of breast and ovarian cancer. After the patient has been examined, her risk of developing breast cancer can be assessed.

Low-risk Medium-risk High-risk
The chance of breast cancer is increased 2–3 times The chance of breast cancer is increased 3–5 times The chance of breast cancer is increased 3–5 times

This risk assessment depends upon the number and age of first-degree (mother, sisters, daughters) and second-degree (grandmothers, aunts, nieces) relatives who have had breast or ovarian cancer. The table below provides a guide to assessing breast cancer risk.

High Risk Medium Risk
4+ relatives affected at any age (breast or ovarian cancer)
3 relatives affected before 40 years old (breast cancer)
3 relatives affected before 60 years old (breast or ovarian cancer)
2 first-degree relatives with both breast and ovarian cancer
Families with Li-Fraumeni syndrome
A family member with a positive test for breast cancer genes
1 first-degree relative with breast cancer before 40 years old
1 second-degree relative (P) with breast cancer before 40 years old
1 first-degree relative with bilateral breast cancer before 60 years old
2 first- or second-degree relatives with breast cancer before 60 years old or with ovarian cancer at any age
1 first- or second-degree relative with breast and ovarian cancer
1 first-degree male relative with breast cancer

Patients in the low-risk group (those having one first-degree relative with breast cancer occurring after the age of 50 years) can be looked after by their GP. They will require standard screening mammography every 18 months once they reach the age of 40. Regular self-examination of the breasts is also recommended.

Those women who have a moderate risk of developing breast cancer will be seen in the breast clinic and examined annually. They are advised to have yearly mammography between ages of 40 and 50 and, thereafter, at 18-month intervals.

High-risk women may carry the breast cancer genes BRCA-1 or BRCA-2. These women should be regularly screened for breast cancer from the age of 30 years or even earlier. Screening tools include clinical examination, high-resolution ultrasound scan, mammography (preferably digital) and more importantly magnetic resonance imaging (MRI). The latter has been shown recently to be more accurate than mammography and ultrasound in detecting breast cancer in high-risk young women. However it is more likely to cause false alarms (called false positive results). In relation to high-risk women, it is important to bear in mind the following points:

  • They have a 50% chance of carrying the faulty gene(s).
  • If they do carry a gene, it does not mean that they will inevitably develop a breast cancer - only approximately 65% of carriers will develop breast cancer by the time that they reach their 80th year.
  • Screening for the faulty genes can easily be carried out if there are living affected relatives who will agree to provide blood samples.
  • Doctors are still not certain regarding what is the best course of action to take for an unaffected gene carrier.