How often do you see BS, Rad, Oncol.

HI kk69Z...

That is an easy question.

Breast Surgeon once a year.

I do not see the radiologist. After I was done I think He wanted to see me every 2 weeks for couple of months. (January 2006)

Oncologist the first 2 years was every 3 months, now its every 4 months.

Once I reach 5 years (hoping and believing) will be once a year.

I was reading your other thread I also had a Lumpectomy.

Femara 5 years.

I hope this helps you.

 Sheila

I have the same question about seeing all these doctors.  I can understand seeing my chemo oncologist every 4 months but I don't see why I need to see the breast surgeon every 6 months (and almost on the same cycle as chemo onc).   My radiation oncologist set me loose after the end of my treatment with just a one year follow-up. 

 I see my chemo oncologist on Thursday and I plan to ask him why I am doing this and tell him that I plan to stop seeing the breast surgeon.  There is no need since I see chemo onc so often.

 I'll let you know what he says.

 Lorrie

You will find that there are almost as many follow-up protocols as there are women.  I think the factors depend on your disease, your side effects, your ongoing treatments/drugs, your personality and sometimes on $$$motivations.  Possibly the docs also want to avoid negligence claims if they don't suggest follow-ups, too.  Defensive medicine, if you will.

I never saw my rad onc once I finished rads 17 years ago.  Saw the bs once a year for 5 years.  Didn't have chemo.  Was on tamoxifen for about 18 months but couldn't tolerate it.

This time around (same breast) I am seeing my bs once a year but he's cutting me loose after next year if all is still well.  That would make it 3 1/2 years since mx.

The med onc I refused to see once finished tx as she was so horrible.  My bs, who is really the head honcho at the breast center, is the only one whose opinion and judgement I trust.  He said there was no need for me to see anyone but him as I am not on any drugs and since I refused rads this time around.

To be realistic, unless you are having routine scans as follow-up, and most of us are not, all the docs do is ask you how you are feeling and check any remaining boob.  The goal is to catch any recurrence as early as possible and also to manage anxiety in the patient.

Saw the bs a few times after surgery (had a postop infection) but not since about 5 weeks postop.

Rad onc said med onc will do all followup.

Med onc will see me every 3 months since I am on tamoxifen. Don't know yet when mammo etc will be scheduled - will see onc next week so will ask. Just fiished rads in August.

Is it $$$$? Well, we have socialized medicine here. I am being closely monitored by ONE doctor, and I feel very well taken care of (and have felt that all the way through treatment).

Leah

I am seeing too many doctors, but I don't know which one(s) to drop.

My PCP insists that I come in for a checkup every 6 months because he has me on Synthroid, Crestor, and a BP med.  He used to write those prescriptions for a full year, but he changed his policy awhile back and now will only write them for 6 months. He does blood work every time to check liver enzymes, TSH, and lipids. He has started doing a "Berkley" lipid panel, which is ridiculously complicated and $$$ but he is convinced it can predict an imminent heart attack. He does nothing related to my BC dx or my mammogram/GYN stuff.  In fact, he would take me off Arimidex and put me on Evista if given the chance (even though Evista is not approved for preventing recurrence).

I see a GYN once a year for the GYN stuff (PAP etc.). The GYN does a breast exam, but it is hurried and superficial, and there is no way he would detect a lump. I don't like going there, because it's the same place a different GYN doc insisted that my previous lump was "just fibrocystic tissue"--at age 55!--when it was really cancer. But, you gotta do what you gotta do, I guess.

That leaves the cancer part.  I get my mammograms at the same Breast Center where I was dx'd in 2008 (it's part of a comprehensive cancer center). They do digital mammos, and the radiologist will decide to follow up with ultrasound right then and there if necessary.  Also, they read the mammos right away and give you the results before you leave (I love that part).  So far, my mammos have been "diagnostic mammos", but I don't know how long that will last.

After each mammo (same day), I see my BS. That means I've been seeing her once a year. She's a surgical onco specializing in BC surgery. She does an extraordinary breast exam--very, very thorough.  And, if she finds something odd, she'll wheel in a portable US machine to take a look before referring me back to radiology for an official US. I don't know how long she will be willing to see me for my "annual" mammogram and breast exam, but I'd like to keep going to her forever. She is way more likely to detect a new lump than the #$!*! GYN docs.

I did have chemo, so I have a med onco.  I am on Arimidex, and my med onco told me she will want to see me regularly as long as she has me on something "that can do me harm."  She said I should see her every 4 months or so, and "alternate" her appts. with those of the BS (they are at the same cancer center).  How do you "alternate" an annual appt. with every-4-month appts???  Haven't figured that out yet.  My onco does blood work every other visit to check liver enzymes and kidney function.  I've been trying to coordinate her blood work with the stuff my PCP does, since there is some duplication. My med onco also does a fabulous breast exam.  Her "pattern" is different from what my BS does, but she is just as careful and thorough.  Between the two of them, somebody is going to find it if I have a new lump.

Then there's the osteo doc.  Last spring I was talking to my med onco about bone loss, and I mentioned that I used to have kidney stones (I was hypercalciuric).  She offered to refer me to an osteoporosis specialist there at the center, to follow up on the calcium loss. Sure enough--I was still pouring out loads of calcium in my urine! So the osteo doc did some more blood work and added a new med; and now I have follow-up appts. with her, too.

<sigh>

I can keep all the meds straight, but scheduling all the doctor appts. and blood work ("medication monitoring") and the refill requests can be dizzying.  It's pretty hard to move on, with all this baggage.

otter 

Wow - I'm glad I found this thread! I just reported elsewhere that I believe my  medical onc is scheduling me too often - he has me coming back EVERY MONTH! My chemo and Herceptin tx's ended in April of this year. I see my BS once a year - he does a extremely thorough exam. I get a mammo on my remaining breast once-a-year (and talk to the radiologist immediately afterwards.) I see my ob/gyn once-a-year (she does a "quicky" breast exam and pap smear) and my PCP does blood work for cholesterol etc once-a-yea; I'm still seeing my PS because I'm getting my nipple/areola surgery this coming November. But why I'm STILL getting scheduled once-a-month with my medical onc is a mystery to me..........he never examines my remaining breast; when I've complained about a cough, he barely listens to my chest; he did order cat scans of the chest and a bone scan when I complained about shortness of breath and bone pain - but that was months ago and all was well (I blame the Arimidex). He takes blood every time I visit........but never tells me the results............never tells me anything about tumor markers, etc........and I keep paying my co-pay, and my insurance company keeps paying him. This is the onc that went bankrupt a few months ago - he had to reorganize his practice and moved a bit further away. At that time, I told him I was leaving, but when he asked me to stay, I said OK (I felt a sense of loyalty to his nurses.)  But now I'd like to switch to an onc that belongs to the same large practice that my ob/gyn. PCP and endocrinologist belong to. (I see the endo once-a-year for my thyroid checkup.) They all can access all my medical records immediately online - and it makes is much easier, especially when they are drawing blood - it avoids duplication.

I'm such a coward about confrontation though............how do I tell my onc that I'm leaving? I've been tempted to lie and tell him my family is moving away..........but I'd be too ashamed of myself to lie. So what do I say? He's a nice older gentleman, but his lack of communication skills have been a sore point with me for a long time. Can any of you wonderful women help me find the words to leave my oncologist?? 

Thanks Iodine for your direct words.........you are right, I shouldn't fret over this. I'll make an appointment with the new onc, to be sure I like him (he comes really well recommended) then sign the release for my records and get out of there. It's been a long time coming..........somehow I'm just a sucker for being "nice" when it's not even required or expected.

swim, I agree with iodine/Dotti. Be polite, be professional ... but don't feel like you need to be "nice".

You do need to be followed by a doc while you're on Arimidex, for sure. I don't know what the standard procedure is. At my cancer center, my med onco wants to do the monitoring; but she said she will share me with my breast surgeon (surgical onco) who does my annual breast exam/mammogram stuff.  Their offices work out alternating appointments -- sort of.

I just went to my BS yesterday for an annual mammogram/breast exam.  Next month, I have a follow-up appt with my med onco, who has ordered some blood work to be done by the time of my appt so we can discuss it. I'll see her again next March or April, but without the lab work. The next appt will be my annual mammogram/BS appt. next September.

That's 3 onco visits in 12 months. (I am not counting all the ancillary stuff, like regular PCP and GYN appts for things unrelated to BC.)  Like iodine/Dotti, I'm being treated at a major university hospital/NCI-desgnated comprehensive cancer center. My BS and my med onco were on the NCCN review panels that wrote the 2009 guidelines for breast screening and for treatment of breast cancer.  I've read those guidelines, and my treatment and follow-up care have been consistent with them.

Last February I asked my med onco how long I would be seeing her, and she said for at least as long as she has me on a drug that can cause harm -- i.e., Arimidex. Yesterday I asked my BS how long I would be able to go to her for my breast exams and have my mammograms done at the breast health center where she's a director.  She said she would continue to see me once a year for 5 years after my surgery. After that, I might be switched over to a nurse practitioner ("if that's okay") in their "survivors' clinic".

I'm not sure what the "survivors' clinic" is. I think it's something new, in response to recent studies suggesting our docs could do more to help us during the post-treatment years and beyond.

I should note that there have been recent studies showing that survival after BC is just as good if the long-term follow-up is done by a primary care doc (in consultation with your onco) and with minimal blood work, scans, etc., assuming the cancer was early-stage and recurrence risk is low. More is not necessarily better... for the patient, at least.

otter 

You have every right to decline diagnostics that have become "routine".  If for no other reason than unnecessary exposure to radiation.  Unless you had an extremely agressive cancer, I can see no reason for mammmo as close as every 3 mos without some physical symptoms to jusitfy the exam.  IMO.  And yes, money can be a huge factor as can laziness --- not taking time to go thru the chart to determine what studies you actually need.

I carry reports and CD's of all my exams and labs just for this reason: they order, I know I've recently had it and I present the report and CD or the lab results.  If they can give me a good medical reason for getting it done again so soon, of course I listen to them.