Who is a breast cancer survivor?
Any woman or man diagnosed with breast cancer. The issue of cancer survivorship encompasses physical, psychosocial and spiritual aspects at all stages of the cancer journey. You are a survivor from the day you are diagnosed.
Why is survivorship care important?
According to the American Cancer Society, there are now more than 13.7 million cancer survivors in the United States. Of these, there are nearly 3 million breast cancer survivors, comprising 41% of all female cancer survivors. Current predictions estimate there will be 18 million Americans living with a history of cancer by the year 2022.
As many survivors have learned, completion of treatment does not necessarily mark the end of the cancer experience. Breast cancer survivors are at an increased risk of certain physical, mental, and emotional side effects, many of which can be prevented or drastically reduced with early detection and intervention. Furthermore, survivors may be at risk for future relapse of their original breast cancer, and will benefit from regular surveillance by their medical team.
What kinds of late side effects may a breast cancer survivor be at risk for?
Recent studies have indicated that some therapies are linked to increased risks of specific long-term side effects for which a patient should be monitored:
▪ Heart complications. For those having received radiation therapy to the chest, specific chemotherapeutic or targeted agents (i.e. Adriamycin, Herceptin).
▪ Learning or memory difficulties. High doses of radiation to the brain or treatment with some chemotherapy agents can lead to learning, memory, or attention difficulties. This issue is currently under extensive study.
▪ Second cancers. Cancer survivors are at an increased risk of developing a second cancer, the type of which largely depends on the specific therapy received for the initial cancer. Some chemotherapy agents may slightly increase the risk of developing hematologic (blood) cancers such as leukemia.
▪ Bone, joint, and muscle issues.Osteoporosis (reduced bone density) is more common among breast cancer survivors than in the general population. Prior or continued treatment with aromatase inhibitors, steroids, or chemotherapy and low levels of activity—all may contribute to an increased risk of developing osteoporosis.
▪ Hormonal changes.Chemotherapy can damage the ovaries in premenopausal women resulting in early menopause, osteoporosis, hot flashes, infertility, and sexual dysfunction. Treatment with aromatase inhibitors or selective estrogen modulators such as tamoxifen can also cause mood swings, weight fluctuations and affect energy levels.
▪ Fatigue. Approximately one-third of cancer survivors report fatigue. The underlying cause of fatigue among these patients is often not known, although lifestyle management and nutritional support can help combat fatigue.
▪ Effects of surgery. Women who have undergone a lumpectomy or mastectomy may experience emotions related to femininity or sexuality due to the disfigurement caused by the surgery, whereas women who have had extensive lymph node removal in one area (lymphadenectomy) may experience significant swelling or pain of the limb to which the removed lymph nodes provided drainage.
Fortunately, with monitoring and intervention (the earlier the better), many of these side effects, whether short-term or long-term, can be effectively dealt with so that survivors can live their lives without these issues. In addition, as research and treatment continue to improve, radiation therapy is becoming more precise, so the cancer cells are targeted while sparing healthy surrounding tissue from its effects. Chemotherapy agents that are associated with increased risk of long-term side effects or second cancers are also being used less and substituted with other agents that are just as effective and not associated with such side effects.
How should I be monitored for potential recurrence of my cancer?
- Regular visits with your doctor every 3-6 months for the first three years, and then every 6-12 months thereafter
- Annual mammography
- Breast self examination
- Regular gynecologic examination
- Genetic counseling evaluation (if applicable based upon personal or family history)
- Reporting any new relevant symptoms to your doctor (new breast lump, rash, nipple discharge, bone pain, chest pain, breathing problems, persistent headaches, etc.)
Note, the following tests are NOT currently recommended on a routine basis for surveillance: bone scan, CT scan, PET scan, breast MRI, or laboratory studies including tumor markers.
|Exercising is an important part of care
What else can I do to help in my care?
- Be proactive! Request a written summary of your treatment course to help you communicate and coordinate your care with your other doctors.
- Get moving: increasing physical activity can potentially reduce cancer risk.
- Eat well: fruits, vegetables, and whole grains as a part of a well balanced diet.
- Live a healthy lifestyle: limit alcohol intake, avoid tobacco use, and use sunscreen to protect your skin.
- Connect with other survivors: check out survivor programs that DBCC offers like the Peer Mentor Support Program, the Survivor Socials or Nurture with Nature events.
|DBCC’s Nurture with Nature Program
- Make use of online resources, including the Delaware Breast Cancer Coalition, ASCO, National Comprehensive Cancer Network (NCCN), American Cancer Society, and Livestrong.