What comes next?

Ann360

After having a lumpectomy in September 2012, I had chemo (4 rounds of T+C) and 33 rads, and had a meeting w/ the medical oncologist yesterday to discuss follow-up plans.

Basically he said he'd check me every 3 months for a few years, and then cut back on that sequence. He'll watch for symptoms, mostly self-reported by me of bone pain, dry cough, weight loss, anything out of the ordinary. He'll monitor blood work for elevated calcium levels (bone mets) and other clues. I'll have a mammogram every 6 months. Noticably absent from this roundup are CT scans.

I'm looking for a sanity check. Is this what is typical for TNBC after lumpectomy, chemo, and radiation? I want to be sure I'm doing all I should be doing.

Thanks for your input.

Ann (TN IDC, 1.5 cm tumor, Stage 1, Grade 3, 0/4 lymph nodes, clear margins, 4 rounds of T+C, 33 rads; age 67)

gillyone

It seems that MOs fall into one of two camps, regular scans or scans only if symptoms indicate the need for a scan. There are many on these boards that want regular scans and others who are happy with the kind of follow up your MO is recommending. So, to answer your question, what your MO has planned for you is perfectly normal. What you have to decide is if this is ok for you. You will find arguments for both sides of the to scan or not to scan debate. All we can do is tell you what we are comfortable with. For what it's worth, my onc is in the no scan camp, and I am ok with that.

yellowdoglady

I think a lot of it has to do with your risk.  You were stage I, no nodes.  You got 4 rounds of chemo and a lot of radiation for what you had. You got a lot of treatment to kill that beast.  You can argue for scans but your insurance may not want to pay for it unless you have a reason.  If it is not necessary to sleep at night, most docs won't put you through that because you are an ideal patient.  Brought in early, given the best treatment, and more than most, and you should be just fine.  You can, of course, ask for a scan, and if it is not approved by your insurance, you can appeal that, and you can pay for the scan.  If that is the case, be sure to talk to the imaging center and make sure that if the insurance won't pay, you will only pay what it would under the contract it has with the imaging center.  Last I heard that was about $1300.  Not a small thing.   

gillyone

Yellowdoglady - I do not believe it is a matter of risk - ie Ann is stage 1, 0 nodes. Obviously stage IV is a different matter, but for stages I - III, MOs seem to have a protocol and fall into yes I will scan regularly, or no scans unless symptoms present. Of course an MO MAY order scans for an individual for peace of mind, but generally they fall into one of the two camps re scanning. There have been many debates on the boards regarding this issue, and other than stage IV, stage does not seem to be the issue. There is also research to suggest that catching mets "early" has no bearing on eventual outcome, and so the argument is why go through the trauma of scans unless it is necessary. But some patients believe scans give them peace of mind, reassurance until the next scan.

And of course the insurance/cost is a whole other ball of wax.

Luah

Ann360: This spells out the current guidelines of ASCO: http://www.cancer.net/publications-and-resources/what-know-ascos-guidelines/what-know-ascos-guideline-follow-care-breast-cancer/recommendations

As you can see, regular scanning is not among ASCO's recommendations. However, some docs do it... perhaps for patient's peace of mind, I don't know. It is not based on medical evidence to date. And scanning is not benign, plenty of radiation in a CT. Something else to consider.... 

gillyone

Good points Luah (as usual).

Ahicks62

I was stage 1 and had the same treatment, and as for followup my oncologist is doing pretty much the exact same thing. Lol even our names are the same I am Ann too.