Who Handles Your Yearly Breast Checks after Cancer Treatment?

I visit my onc every 3 months and he does an exam. I also go to have a yearly mammogram on my healthy breast. I need to be more vigilant on doing exams on myself...

There are survivorship guidelines put out by ASCO (American Society of Clinical Oncologists)

http://www.cancer.net/portal/site/patient/menuitem.169f5d85214941ccfd748f68ee37a01d/?vgnextoid=54fa28e76473e010VgnVCM100000ed730ad1RCRD 

They actually don't recommend tumor markers or MRI--but as a routine, every case is different. They do discuss figuring out who should be the physician who orders tests.

I get an MRI 6 months after the mammogram currently as my breasts are too dense to see anything, per the radiologist, so my med onc orders the MRI.

I see the med onc every 6 months, the breast surgeon yearly, scheduled to see the rad onc yearly but might skip that, see my gyn yearly (on tamoxifen and needed a D&C last year) and my PCP yearly. Too many visits for me, but I let the med onc order the mammograms and MRI's.

Kira 

I'm happy to let  any doctor check my breasts.  I look at it as many eyes ( or should I say hands) looking out for my welfare. I also check myself on a regular basis.  I am a 17 month survivor.  My BS sees me twice a year to check my breasts. She has me alternate every 6 months between a mammogram & a mri. That way I am getting some type of scan routinely. When I see my onc he also checks my breasts as does my gyn.

lopsided blogger,

I didn't have the options I needed locally, either; so I gladly agreed when my PCP offered to refer me to an NCI-designated cancer center for definitive dx and eventual tx of my BC. The cancer center is at a large university hospital 2 hours away, but they have a comprehensive breast health center and that's made all the difference for me.

My BC was dx'd at the breast health center nearly 2 years ago. I was immediately assigned an "oncology team" consisting of a breast surgeon (who is a surgical onco), a med onco, and a radiation onco. I chose a mast/SNB with no recon, and I didn't need to see the rad onco again after that introductory appt. My surgery was in Feb. '08, and I finished chemo in June '08 (17 months ago).

I see my breast surgeon once a year. She has been ordering annual "diagnostic" (not screening) mammograms on my remaining breast, and I get the results before I leave the mammography center. My appt. with my BS is an hour or two later that same day.  She reviews my mammo results, goes over my medical history and anything else that needs to be discussed, and does a very thorough exam of my mast/SNB incision, chest wall, remaining breast, armpits, nodes, etc.  She's the doc who gave me prescriptions for lymphedema compression garments and LE therapy.  I asked her last time (Sept. '09) how long I could continue to see her, and she said for 5 years; after that, I could "transition" to the long-term "cancer survivors" clinic.

In between visits with my surgeon, I see my med onco. Those med onco appts. end up being twice a year, separated from the BS appts. by 3 or 4 months. My med onco and BS are at the same cancer center and they work together (weekly meetings to discuss patients, coordinated medical records, etc.). My med onco said she wants to monitor me as long as she has me on Arimidex.  She orders blood work at every other visit, watching to be sure the Arimidex isn't doing bad things to my liver.  The results of the blood work are available in time for my appt. with her that same day.  She also takes a medical history and discusses stuff with me; and she does a very good breast exam (different pattern, but just as thorough as the one my BS does).

<sigh> As of this year, I've also been going to an osteoporosis specialist at the university hospital.  That's because 1) I am on Arimidex; 2) I already have very early osteopenia (as per pre-Arimidex baseline DEXA); and 3) I have "idiopathic hypercalciuria," which causes me to excrete way too much calcium in my urine.  So, the osteo doc has me on a drug to reduce that unusual loss of calcium; plus, I cannot take the mega-doses of calcium and Vitamin D that other women take or I would get kidney stones.  The osteo doc has scheduled my next DEXA scan and a follow-up appt with her next summer.  She doesn't do a breast exam or anything else.  I'm hoping my DEXA is okay; otherwise I'll be seeing even more of her, because she's the one who would put me on a bisphosphonate.  I would not be seeing her at all, if it wasn't for that darn hypercalciuria.

There's another doc who "handles" my breast exams....  my GYN.  I don't trust him, though. He's okay for the necessary exams "down there" and for PAP smears; but his breast exam technique is way too hurried and incomplete.  That's okay -- my onco docs cover that ground for me.

Finally, I have a conscientious PCP (the one who referred me to the breast health center 2 years ago).  He oversees my general medical care, including meds for blood pressure, cholesterol, and low thyroid.  That means blood work and a "routine" visit with him every 6 months. I really, really don't think I need to see him that often, because I have all those other docs I must see; but he won't renew my prescriptions without a recheck every 6 months. 

BTW, don't assume that you would automatically get alternating mammograms and MRI's if you were being followed at a big cancer center.  In my case, it's just the opposite. My BS and med onco follow the NCCN guidelines (which the two of them helped write, apparently); and I am not in the "high-risk" category, according to the NCCN definition of "high risk."  From what I've seen, my insurance company follows those same guidelines, which are also consistent with the guidelines from the American Cancer Society on the use of breast MRI for screening.  I'm not complaining -- someone has to set the guidelines, and my insurance company hasn't balked at anything else related to my BC dx or tx ... so far, anyway.

otter 

I finished treatment (mast, chemo, rads) in mid-Aug. Now on a schedule of seeing med onc every 3 months. He recently said, go for mammo and u/s so that's scheduled for this week. Don't see rad onc or bs for folow-up and frankly don't see a need - med onc will check what needs to be checked.

See gyno once a year. After I started the tamox she sent me for u/s. See pcp for anything else (like the bladder infections the tamox has been giving me, etc) but with all the medical "stuff" I've had there's been no need for a regular checkup.

However.

It took me 3 1/2 weeks from the time the onc said to get the mammo and u/s for me to pick up the phone and make the appt. Am I stressed by it?

Freaking out would be a better description.

Leah

Move your care to medical oncologist or primary care doctor. There is very little reason to have the radiation oncologist be your main caregiver.

I still see all 3 oncs but alternating one every 6 months for followup.

I  have the 'many eyes' attitude too.  I see my onc every 4, my breast surgeon every 6 and my gp yearly.  Everyone one of them does an exam.  I will continue to do this.  If i were to just choose one, I would choose my onc. She is an expert in the bc field and I trust her immensely!