How many years of followups are necessary?
I stopped seeing my MO last summer, when I quit Tamoxifen. My RO had left his practice, and I didn't sign on with the new one. The extent of my DCIS was nil -- nothing was found in the lumpectomy tissue, so it must have all been removed with the initial biopsy.
I get annual mammograms, annual ob/gyn exam. Am I good to go? Or does DCIS warrant followups for a decade or two?
Comments
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My BS at the University Medical Center in Tucson said new guidelines say that those with DCIS only need follow up for 3 years. All other cancers it is still 5 years. She did say if I wanted to be seen for the additional 2 years, for peace of mind, she would.
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Think you are good to go.
Congrats!
I'm 2 years out now (lump+rads, no tamox) and am just seen by my bs once/year, directly after my diagnostic mammogram and ultrasound.
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CTMOM- I love your tag line!
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Working in a cancer center and with my own doctors, breast cancer is not like other cancers, that a 5 year follow is the norm, not for breast cancer, I would still have a follow up for years to come for also a DCIS.
Breast cancer can come back after many years and in any place of the body, I see my oncologist once a year, same with my surgeon, they are the same that treated me.
I am 20 years from DX, and was reading on one of the post a lady had a recurrence, it was same type after 19 years.
I have also seen at work , patients coming back with recurrences after several years, but because they had a very good follow up, all cancers were caught early.
I had biopsies doen 10 years from my diagnosis when I had microcalcifications in my chest wall, they were removed.
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Dreaming, how did they catch the recurrance? In followup, my oncologists never ordered a blood test, MRI, U/S, or mammogram, other than the annual mammo. I just didn't see the point, since all they were doing was a breast exam. I do that, as well as my ob//gyn.
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I have the same question as Blinx...what are all of these follow-ups for? I understand getting 6 month mamograms, but doesnt the radiologist usually read them? What additional would a BS, RO or any other doctor do to detect the cancer?
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I have been discharged from all follow ups now, it's two years since dx and 18months past chemo. They told me recurrences are usually found by the patients, I am 47 now and wonder if that is good enough.
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I've wondered the very same thing. I'm three years out from surgery (DCIS grade 3, lumpectomy), followed by seven weeks of full-breast radiation, and almost three years on Arimidex. When I see the radiation oncologist (twice a year for the past three years and I negotiated it down to once a year now), all they do is ask what meds I'm taking, take my temperature and blood pressure, then the doctor gives a two-minute breast exam and listens to my heart. Then I'm told to keep having six-month mammograms.
I asked how long I'd have to go back to the radiation oncologist and was told once a year for the REST OF MY LIFE. But other people I know haven't been told this!
Beesie, are you out there?
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I had IDC which I know is a different beast, but I will followed up with . . . forever. Currently I have appointments every 12 weeks. After 2 years from dx appointments will move to every 4 months. Then, after 5 years I can been seen every 6 months. My MO made it sound like I would see him for the rest of his/my lifetime. Anyone else have this stringent of a survellience plan?
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I was told by my BS that he would follow up with me forever. It sounds like this is not the norm for DCIS. He has me on a high risk screening schedule (extensive family history, but BRCA neg.) with alternating MRI's and mammos every 6 months followed by visits with him and ultrasounds if needed. In addition, I am still seeing the MO every 6 months although I have declined tamoxifen. With this schedule, I am having a clinical breast exam every 3 months. (I sometimes think they are following me too closely.) The RO released me about 4 months after I finished radiation; actually he gave me the choice of continuing follow-ups with him or not. I chose not to -- I hated everything about radiation and was glad not to return.
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Ctmom why did you decline the tamoxafin? I've been told I'm estrogen + and that was a good thing cause it reduces chance of reaccurance. I have a low grade DCIS. TKS
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I just had my 6 month visit to my MO this past week.
I also see my BS once a year, when I asked her why and for how long, she said forever unless I chose not to see her. I am on aromasin and have 2 years remaining on my 5 years, not sure if my followups will change when I end the meds.
I am not fighting the followups and feel it is best to have someone checking on me, DCIS is nasty little things and I want to be sure that they do no show up elsewhere. I have only this past year gone from 6 month to yearly mamos again.
As long as I have health insurance to cover, I will follow the plan
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BKZOE - Each of us is given statistics for our individual medical circumstances. And each treatment has pros and cons. For me (and I stress that is for me), the 2-3% estimated percent decrease in having a recurrence did not outweigh the risks of taking tamoxifen. The onc. was very honest about the pros and cons, with the larger benefit possibly being to reduce chances in the other side.
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Thanks for all of your responses. It's interesting that for some with the same Dx and similar family history, the followups really vary! If they're absolutely necessary, that's fine, but sometimes it seems like a racket, particularly if you have good insurance and they know it! But then maybe I'm just paraoid.
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Just to add from my side---my BS said 3 months x 1 year, then 6 months x1 year, then yearly with mammo and mri... FOREVER!!! I had bmx in May 2011. She said that if anything tried to pop up she wants to treat asap. Some will think it is overkill but i think my kids will appreciate it if i can stick around as long as possible
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BS is breast surgeon? Why would anyone need to see a BS after the surgery?
When I go for my 3 month followups at the Cancer Center they test my blood for something that tells them about the cancer margins? I don't remember what they called it right now.
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From what I have been told they don't test blood for tumor markers for DCIS patients since we are by definition, non invasive. I'm seeing my oncologist every 6 mos for at least the next 4 1/2 years while I am on Tamoxifen, and then I guess we'll go from there. I am also having at least a mammo. every 6 mos. I am scheduled for my first MRI at the one year mark in April to watch my natural breast.
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For DCIS follow-up should be for the rest of your life. The reasons are:
1. DCIS can recur after a very long time, unlike some aggressive invasive breast cancers that will usually recur within a few years if they are going to recur at all. Our risk is lower than many of our sisters but there is no reason to be relieved at 3 years or 5 years or whatever.
2. If DCIS does recur it will usually start with a local recurrence in the breast, whether the recurrence is DCIS or invasive. Finding it early gives us a very good chance of treating it and having a very good prognosis even though it recurred. Unfortunately if some more aggressive breast cancers do recur they will probably recur in the nodes or more distant locations. The benefit of catching it early is still real for DCIS patients.
The questions for DCIS follow-up revolve around what doctors should you follow-up with, how often, and what is sufficient follow-up. Do you need the medical oncologist, breast surgeon, radiation oncologist, gynecologist, PCP? That seems like too many doctors! I think most of us would drop some of those, but it may depend less on the specialty than circumstances (e.g. one left the original practice) or the quality of your relationship with each particular doctor. What tests do we need? ...mammograms, MRI, blood work? Those recommendations seem to be all over the board.
At 2.5 years out I am seeing the med onc every 6 months because I am on tamoxifen, the rad onc once a year, and the gynecologist once a year. The breast surgeon left the practice soon after my treatment was done and I have not looked for another. I now get mammos and blood work once a year.
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I could not answer earlier, with my diagnosis of Basal Cell Carcinoma, had to get use to my large scar on my face., and several biospies.
There were a couple of posting about recurrences after many years, I cant remember how they found, but I bet you can search in the posts.
I see an oncologist once a year,also a surgeon. I get a brain scan every couple of years, a vaginal ultrasound once a year, blood work and they do the markers for ovarian cancer, we have higher risk.
I do monthly breast exam in the shower, I had reconstruction, but still I can feel any changes.
There is not really a "protocol"to follow, I made my own. Somebody mention, 5 years do not count for BC.
My original doctors are retired,but I found new ones. Follow up is for the rest of our lives.
Because we are long term survivors we can not let our guard done.
I took Tamoxifen for a few months but it was hard on me, my oncologist told me that my survival with tamoxifen would go from 70% to 73% , it was not worth for me,stopped taking it.
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I was told I will see my breast surgeon forever, once a year. DCIS double mastectomy, no chemo, no rads.
Then I also still see my gyn, so every 6 months, the area is looked at...but I wonder if there should be any MRI's? what is the situation after a double mastectomy?
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@Denise--we continue to see a breast surgeon for follow up because they are the most familiar with breasts!! I do not need to see my onc unless something changes. My gyn does breast exams yearly. Who else would follow you for a possible reoccurrance???
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I've been told I will have five years of follow up, every 6 months and a yearly mammogram. However I will only be 41 by the time I come out of that programme. At that point Ive already decided I will be paying for mammo's myself, because here in the UK the mammo screening programme on the NHS doesnt start until you are in your early fifties. So I'm not taking that chance!
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I'm an 11 year DCIS survivor and still am confused as to what follow up I should have due to doctors not saying the same thing. I was diagnosed in 2001 from a routime mammography as I had no signs or symptoms. My left breast then needed 6 biopsies to confirm dx. The left nipple had DCIS and I was told I had a 75% chance of the right breast getting it. I could not wake up everyday in fear, nor could I have a test everyday so with much fear and uncertainty I came to a decision. I had a double mastectomy with immediate reconstruction with saline implants. Four lymph nodes were removed, tested and were clear. I recouperated at home for only 4 weeks as I had just started a new job and that's all I was allowed. I then had 6 weeks of radiation and was on Tamoxifen for 5 years. I saw my oncologist and surgeon at the time every 6 months along with a yearly breast MRI. I tired a mammography 2x and it was so painful and they were afraid of pressing and popping the implants. Then oncologist and surgeon said a mammography wasn't needed because I had no breast tissue left to view. I drove myself crazy with not knowing what to do and for my own peace of mind, insisted on the yearly breast MRI. I then decided instead of seeing so many doctors, I would just see my gyn every 6 months and have a manual breast exam. To this day I am still doing that. SO I would really like to know what follow ups are needed. I lost my job and with no health insurance, paying out of pocket is very expensive, but my life is very important.
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Dmh-- my BS said that it is not possible to get all the breast tissue- only approx 90%. She recommends mammograms with mriyou yearly so if there is anything brewing in any left over tissue she can act on it ASAP. Mammos can also pick up nodes and surrounding tissue. She alsocan does breastthe exams every 6 months. Once again I think it comes down to what you are comfortable with. I am a self proclaimed worry wart and this close follow up helps me sleep at night.
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Mammos w/ mri yearly-- stupid phone
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