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NCCN Guidelines for Patients



Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017

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.

Cancer tests

Medical history and physical exam

As noted in

Guide 12

, 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

the 6


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.

Imaging tests

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

Medicine check

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

get relief.

GYN exam

If on tamoxifen, you need a GYN (


ecologic) exam

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.


Follow-up care

Cancer tests


Side effect care