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After your breast cancer surgery, whether it's a lumpectomy or mastectomy, monitoring and screening are crucial to detect any potential recurrence or new developments.

The specific screening and follow-up plan can vary depending on your medical history, the stage of the cancer, the type of surgery performed, and other factors.

Your primary healthcare provider has a good understanding of your individual risk factors for breast cancer recurrence. These include tumor characteristics, lymph node involvement, hormone receptor status, and genetic factors.

That knowledge, along with your active participation in your healthcare, will guide the frequency and type of breast cancer screening.

An important tool in your breast cancer recovery journey is the American Society of Clinical Oncology (ASCO) "." This 3-page downloadable form will allow you to share your treatment and follow-up with any healthcare provider so you can receive the best care tailored to your individual needs. It will also help you be aware of and adhere to recommended screening guidelines.

Clinical Breast Exam

Regular conducted by a healthcare professional can help detect any changes or abnormalities in the breast tissue, such as thickening or lumps, and adjacent areas, such as the lymph nodes near your armpits. Breast physical exams by a healthcare professional are recommended every 3 to 4 months.

from the American Cancer Society (ACS) and ASCO offer this specific schedule for clinical breast exams after treatment for invasive cancer:

• 2-4 times a year for the first 3 years after active treatment ends

• 1-2 two times a year for the next 2 years

• Once a year after that

Guidelines also call for surveillance imaging of ductal carcinoma in situ (DCIS) breast cancer every 6-12 months for 5 years and then annually. The National Comprehensive Cancer Network (NCCN) recommends that patients with DCIS follow up with a physical exam every 6-12 months.

Patient Breast Self-Exam

Reviewing techniques for may be helpful for people who have undergone a lumpectomy or partial mastectomy, as this may increase the odds of early detection of breast cancer.

Healthcare advocacy groups such as , the , and from the National Library of Medicine offer step-by-step guidance on conducting a breast self-exam.

Breast self-exam should be done on a . Breast changes to be alert for include breast tissue that feels different (harder or tighter); changes in the skin's texture (puckering, dimpling, a rash or thickening); a lump or lumpy area you can feel in the breast or armpit; swelling of the upper arm; discharge from an intact nipple; rash or swelling on the intact nipple or the areola; and/or pain or discomfort in the breast area.

If you have undergone breast reconstruction, you will want to check for anything that feels unusual in your reconstructed breast (feeling swollen or firmer, harder, or tighter) or change in the appearance or shape of a breast.

If any changes do occur, be sure to notify your healthcare providers as soon as possible.

Mammography

after breast surgery will be based on the type of surgery you had:

• Double or bilateral mastectomy (both breasts removed): Routine screening mammograms are generally not required. If your healthcare provider thinks you are at high risk for breast cancer recurrence, you may continue to get screened with mammograms and/or imaging modalities (see below).

• Breast reconstruction performed after a mastectomy: Routine screening mammograms are generally not required, as there usually isn't enough deep breast tissue left for cancer to return. However, if breast cancer does return, it would most likely appear on the surface of the breast where it can be felt during a routine clinical exam.

• Breast-conserving surgery performed (either a lumpectomy or partial mastectomy): Screening mammogram about 6-12 months after surgery and radiation therapy are completed; after that, a mammogram at least every year on both breasts. The first mammogram after breast-conserving surgery and radiation therapy will become the new standard against which future mammograms of the remaining breast tissue are compared.

If you have silicone implants, you should have an imaging study with other types of imaging (see below) rather than mammography to monitor the implants for potential rupture. The FDA recommends that this occur 5-6 years after surgery, and then every 2-3 years.

Other Types of Imaging

Your healthcare provider may opt for you to undergo imaging in addition to, or instead of, mammography. These other imaging approaches include ultrasound, magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT, also known as 3D mammography), and computed tomography (CT).

Your healthcare provider will help you determine if one of these imaging tests is right for you. For instance, if your provider suspects you are at high risk of breast cancer recurrence, they may recommend imaging with:

• : For characterizing potential abnormalities seen on mammography or breast MRI; for people who are at high risk for breast cancer but are unable to undergo an MRI; for those who are pregnant or should not be exposed to the x-rays used in mammography; for those with increased breast density, or breasts that have a lot of glandular and connective tissue and not much fatty tissue.

• : Routine screening with MRI should be reserved for patients who meet high-risk criteria for increased breast cancer surveillance as per ACS. According to ACS, high risk is defined as a woman with a lifetime risk of a second primary breast cancer greater than 20%, such as a woman with a BRCA1/BRCA2 mutation or a very strong family history of breast cancer. A reason for annual MRI screening according to NCCN is a personal history of breast cancer for those who were diagnosed at up to age 50 or have dense breasts.

• : Can be used for screening mammography, particularly for women with increased breast density; can be used as a diagnostic tool to detect and diagnose disease in breasts with lumps, pain, skin dimpling, or nipple discharge.

• : For presurgical cancer assessment; for determining if the cancer has spread to other areas of the body.

Laboratory Testing for Breast Cancer Screening

Guidelines do not support routine lab tests for monitoring cancer after treatment. Blood-based tests, such as the test, are not currently recommended, but may be an option in the future.

Read previous installments in this series:

For Your Patients: Breast Cancer Basics

For Your Patients: The Crucial Role of the Biopsy in Breast Cancer

For Your Patients: Understanding Early-Stage Breast Cancer

For Your Patients: New Therapies, New Hope in Later-Stage Breast Cancer

For Your Patients: The Importance of Genes in Breast Cancer

For Your Patients: Understanding Palliative Care for Breast Cancer

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.