Follow-up care for breast ca survivors. (Long-Term Management).

Good primary health care with standard health screening is the best way to manage long-term follow-up care for survivors of breast cancer.

Women who have been treated for breast cancer stand a 30%40% chance of recurrence, and complications from treatment are rare, experts say. So their primary care physicians should focus on the health issues that are important to any female patient.

"The first rule of long-term follow-up care is to pay attention to routine primary health care screening," said Dr. Steven Edge, chair of breast and soft tissue surgery at the Roswell Park Cancer Institute in Buffalo, N.Y.

Aggressive screening for recurrent breast cancer or for the endometrial cancers that are rarely associated with tamoxifen therapy hasn't been proved to increase survival. In fact, such procedures often precipitate unnecessary medical intervention for treatable illnesses that can be caught with routine screening and for metastatic cancers that will probably be uncurable.

Dr. Robert Carlson, a medical oncologist at Stanford (Calif.) University Medical Center, agrees. "It can even be argued that diagnosis of recurrent breast cancer while a woman is asymptomatic does nothing but precipitate treatment that will make a woman symptomatic, and it has no known survival advantage," he said.

The American Society of Clinical Oncology recommends an annual pelvic exam and a history and physical every 3-6 months for the first 3 years following treatment, then every 6-12 months for 2 years, and then annually. The group also recommends monthly breast self-exam and screening for other cancers. (See chart.)

This method of health care will identify most problems that could arise from breast cancer--either complications from therapy or a recurrence of cancer. Of those who have a recurrence, 80% experience it by 5 years post treatment, and this figure emphasizes the importance of breast self-exam and annual mammography Even if more aggressive screening were pursued, Dr. Edge said, there is no screen that will either identify an early recurrence or metastasis, or reassure patients that they will never have one.