NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
Follow-up care is important for your long-
term health. It is started when there are
no signs of cancer. You may still be taking
a HER2 antibody or endocrine therapy.
Read Part 7 to learn which types of health
care are advised.
Medical history and physical exam
As noted in
, a medical history and
physical exam will occur at follow-up visits. These
visits should occur between 1 and 4 times a year as
needed for the first 5 years. If results are normal, you
should then have these visits every year starting in
year after cancer treatment.
During your visit with your doctor, tell him or her
about any new or worse symptoms you have. There
may be ways to get relief. Also, tell your team about
any new cases of cancer in your family. Your doctor
may refer you to a genetic counselor.
Breasts treated with breast-conserving therapy
should be assessed with mammograms. A
mammogram every 12 months is advised. The first
mammogram should occur at least 6 months after
radiation ends. Mammograms will be continued for
cancer screening of a breast that hasn’t had cancer.
Routine use of other breast imaging isn’t advised.
Mammograms aren’t done after mastectomy
since the breast has been removed. Imaging of
reconstructed breasts on a regular basis isn’t
needed. Screening for metastases isn’t needed
unless cancer signs or symptoms appear.
Side effect care
If on endocrine therapy, don’t stop taking your
medicine. If you do, the cancer will be more likely to
return. Tell your doctor about any side effects that
make you think about quitting. There may be ways to
If on tamoxifen, you need a GYN (
each year. This drug can increase your chance for
cancer of the uterus. Tell your doctor if you’ve had
any vaginal bleeding that isn’t normal for you. If not
on tamoxifen, continue your routine GYN care. For all
women, all routine health care should be done.
Bone mineral density
Regular testing of bone mineral density is needed
in two cases. Get tested if on an aromatase inhibitor
and if cancer treatments caused menopause.
Aromatase inhibitors and starting menopause early
can cause bone loss. Bone mineral density tests
reveal how strong your bones are. These tests use
Lymphedema is swelling due to buildup of lymph
fluid. It occurs in the arms after lymph node removal.
It may happen just after surgery or months to
years later or never. It’s important to know about
lymphedema so you can watch out for it.
If you have lymphedema, your doctor will assess it
at follow-up visits. He or she will also refer you to an
expert in lymphedema management. The swelling
may be reduced by exercise, massage, compression
sleeves, and other means.
Side effect care