Since you are doing well, your primary care provider (family doctor or nurse practitioner) can safely do your recommended follow-up, which includes:

• Arranging tests to check for cancer (surveillance)
• Continuing to see you for any health conditions you have, or any new problems
• Referring you to a specialist or back to your cancer doctor if they have any concerns.

• Have a mammogram of your breast(s) every year. If you’ve had a complete mastectomy, or a complete mastectomy with reconstruction, mammograms are not needed on that side.
  
  Supplemental breast ultrasound can be added to mammography if you have extremely dense breast tissue (American College of Radiology category D), and/or at the discretion of the reading radiologist.
• Have an exam of your breast(s) and/or chest wall (mastectomy site) and armpits every 6 months for 2 years, and then once a year after that.

Tell your doctor immediately about any new worrisome breast lumps, skin lumps, or other symptoms that do not go away.

There is no evidence to support the use of Breast Self-Examinations (BSEs) as a cancer screening method. To learn more about recognizable signs and symptoms of breast cancer, visit Breast Screening - Screening for Life.

If you need a family doctor, you can find one by calling Health Link (811) or visit Alberta Find a Provider. Once you have a doctor, let them know they can view the healthcare provider follow-up recommendations at ahs.ca/guru.

• New lump in your breast, neck or armpit
• Changes in the contour, shape or size of your breast
• Nipple retraction (turns in instead of out)
• Swelling in chest or arm
• New rash or nodule (small lump) on your chest wall
  Changes near or along the surgical scar
• New & persistent (won’t go away):
  • Bone pain
  • Shortness of breath or cough
  • Abdominal discomfort
  • Headache

Some post-menopausal women with breast cancer may be prescribed bisphosphonate medications (like clodronate, zoledronic acid) for 2-5 years to help prevent their breast cancer from coming back.

Bisphosphonates also help improve bone density and reduce the risk of having a bone break or fracture. Tell your dentist that you are on bisphosphonate before having any procedures. See your dentist if you have a persistent mouth sore or persistent pain in a tooth or your jaw.

Endocrine therapy like tamoxifen, anastrozole (Arimidex®), letrozole (Femara®) and exemestane (Aromasin®) is prescribed for estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer. Endocrine therapy works by blocking the hormones to keep the cancer from growing. This therapy is recommended for at least 5 years (up to 10 years) to reduce the risk of your breast cancer from coming back.

It is very important to take this medication for the prescribed amount of time. Your cancer doctor will prescribe your endocrine therapy while you are being seen at the cancer centre. Side effects of endocrine therapy often feel similar to symptoms of menopause because the goal of treatment is to stop or block the hormones in your body. If you have side effects that are difficult to manage, talk to your doctor.

Your initial prescription for endocrine therapy will be dispensed free of charge to you from the Cancer Centre Pharmacy. Further prescriptions will be filled by your primary health care provider, but you can bring your prescription (or ask your doctor's office to fax refill prescriptions) to your Cancer Centre Pharmacy. If you live out of town, check to see if the Cancer Centre Pharmacy can mail your medication to you.

Possible Side Effects of Endocrine (Hormone) Therapy

• The most common side effect for most endocrine therapy is hot flashes
• Tamoxifen side effects:
  • Some rare but serious side effects can happen. Follow these recommendations:

    RARE Side Effect	Symptoms to Watch For	Recommendations
    Cancer of the uterus	Vaginal bleeding that doesn’t go away, or unusual vaginal discharge with blood	STOP Tamoxifen and call your primary care provider for medical advice
    Blood clots in veins	One-sided swollen or painful leg (or rarely arm)	STOP Tamoxifen and seek immediate medical attention
    Blood clot in lung	Sudden feeling of shortness of breath, chest pain, or coughing up blood	STOP Tamoxifen and seek immediate medical attention

• Aromatase Inhibitors (like anastrozole, letrozole, or exemestane)
  • You may have muscle aches or pain and joint pain or swelling. It may also cause your bones to thin (osteopenia) or become fragile (osteoporosis) over time. This can increase your risk of breaking a bone. Take vitamin D and calcium supplements and exercise regularly.
• Bone density:
  • If you are post-menopausal (stop having menstrual periods for longer than 12 months because of changes in your body’s hormone levels), talk to your family doctor about monitoring your bone density. If you are diagnosed with thin bones, or are at high risk for breaking a bone, your doctor may prescribe you medications to help strengthen your bones.

We do not recommend becoming pregnant while on endocrine therapy. Sometimes your menstrual cycle (periods) will stop during treatment. This does not necessarily mean you are in menopause. The younger you are, the more likely your periods will return after treatment and the older you are, the more likely they will not return.

Non-hormonal forms of birth control, like condoms or an intrauterine device (IUD), are recommended. If you are considering pregnancy, talk to your doctor to find out the right timing for you and if you need a referral to a fertility specialist.

Menopause is the time when you stop having menstrual periods because of changes in your body’s hormone levels. For people who have treatment for breast cancer, endocrine therapy (hormone therapy) can cause menopause symptoms and chemotherapy can cause early menopause. Hormone replacement therapy is not recommended for women with breast cancer because it can increase the chance of the cancer returning.

Symptoms, such as hot flashes, can be managed with non-hormone therapies and vaginal dryness can be managed with non-hormonal vaginal moisturizer (see Sexual Health Concerns section). Other suggestions are included in the After Treatment Book.

Treatment for breast cancer can impact your sexual health, relationships, and sometimes causes distress over body image. There are things you can do to help manage concerns, like vaginal dryness and hot flashes. Physical changes may be managed with a mastectomy bra or prosthesis or for some women, with breast reconstruction.

Strategies and support are also available to help you and your partner with intimacy problems, distress, and adjusting to these changes. See Sexual Health & Cancer for resources to help you, and contact information to book an appointment with our Sexual Health Consultants.

Resources for low sexual desire, women’s sexual health (including vaginal dryness) and fertility are available at your cancer centre or see Cancer & Sexuality MyHealth.Alberta.ca.