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Although breast cancer treatments continue to show great improvement, they still have the potential for far-reaching side effects. In addition, some breast cancer survivors may develop metabolic syndrome or subsequent primary cancers as a result of their treatment.

A "comorbidity" means a coexisting health condition, such as two or more disorders or illnesses that occur simultaneously in the same person. Different treatments have different side effects, and you may or may not experience the potential comorbidities noted below. Your healthcare team will monitor for and discuss the following possibilities with you as part of your long-term treatment plan:

Cardiovascular Complications

Some breast cancer treatments, such as radiation therapy and certain chemotherapy drugs (such as anthracyclines), can increase the risk of cardiovascular diseases in the long term.

The American Heart Association recommends that all people treated for cancer be assisted with management of their nutrition, weight, blood pressure, and diabetes (if applicable), and have their lipid levels checked on a regular basis – but, most importantly, that regular exercise should be a consistent part of their routine post-treatment.

Osteoporosis and Bone Health

Breast cancer survivors are at increased risk of osteoporosis due to hormonal therapies such as aromatase inhibitors or premature menopause induced by chemotherapy. It is recommended that your bone mineral density be assessed on a regular basis.

Lymphedema

Surgery and radiation therapy can damage the lymphatic system, leading to tissue swelling caused by an accumulation of fluid that's usually drained through the lymphatic system. Lymphedema may be an ongoing concern for those who have undergone breast cancer treatment, with the potential for the condition to start even years after the initial therapy.

Cognitive Dysfunction

Although cognitive impairment -- i.e., "chemo brain" -- is usually mild and transitory for the majority of patients and abates within 6-12 months after treatment, some people may have persistent impairment that continues for years.

Emotional and Psychological Well-Being

Long-term survivors of breast cancer may face emotional and psychological challenges, including anxiety, depression, fear of recurrence, and body image issues. This is neither unusual nor unexpected.

Report any changes or issues during your regular follow-up visits. Your healthcare team will be able to provide you with the resources you may require.

Pain and Fatigue

Chronic pain and fatigue are common among people who have been treated for breast cancer, even years after the completion of treatment. Risk factors for chronic pain are young age when treatment starts; existing healthcare issues such as back pain, arthritis, osteoarthrosis, pre-existing neuropathy, and fibromyalgia; and combinations of breast cancer treatment such as surgery, chemotherapy, and radiation therapy.

Lifestyle changes such as maintaining a healthy weight, a healthy diet, ceasing smoking, and an exercise routine combining aerobic and resistance training, appear to successfully reduce pain intensity and improve quality of life.

Fatigue as a result of breast cancer treatment is very common. If you are experiencing fatigue, report this to your healthcare team, and they should be able to address your concerns and provide you with the necessary resources to help.

Sexual Health Concerns

Breast cancer treatments can impact sexual function and fertility. Common treatments may result in induced menopause and decrease vaginal lubrication, affecting sexual excitement and desire. Sexual health concerns may crop up soon after diagnosis and may remain an issue even years after treatment.

Share your sexual health status and concerns with your healthcare team at every visit. This will enable them to best address any potential issues as soon as possible and provide you with supportive care.

Metabolic Syndrome

Some people who have undergone breast cancer therapy may develop metabolic syndrome -- a cluster of conditions including obesity, high blood pressure, abnormal lipid levels, and insulin resistance. Metabolic syndrome can increase the risk of cardiovascular disease and type 2 diabetes, and affect the recovery process.

If you were postmenopausal when your treatment began, you may be at a higher risk for metabolic syndrome, which may occur at the completion of chemotherapy or years later.

Subsequent Primary Cancer

Certain breast cancer treatments, such as radiation therapy and some types of chemotherapy, may increase the risk of developing subsequent primary cancer such as leukemia or other solid tumors.

The risk of subsequent primary cancer could also be related to the subtype of breast cancer. For example, people who were diagnosed with hormone receptor (HR)-negative breast cancer have a higher risk of developing a new cancer compared with those with HR-positive breast cancer.

Follow-Up and Survivorship Care

The establishment of a survivorship care plan includes regular follow-up visits and screening for long-term comorbidities.

Because nearly half of those who have undergone breast cancer treatment suffer from at least one severe post-treatment symptom, a survivorship care plan is of great importance in mitigating potential treatment-related comorbidities as well as providing optimal, quality care.

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

For Your Patients: Next Steps After Breast Cancer Surgery

For Your Patients: Partner With Your Primary Care Doc for Help With Side Effects

"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.