• Do not be surprised if some symptoms continue.
  • If they do, that doesn't mean they won't go away eventually.
  • There are generally steps to take to reduce the effect of all symptoms. 
• Lymphedema may still show up. Do what you can to prevent it.
• Women who have had breast cancer are at increased risk for developing a second breast cancer.
  • Give yourself a monthly breast exam.
  • Get a breast cancer follow-up plan if you don't have one already.
    • Report  all changes noted in the follow-up plan as well asunexpected changes in your health to both your oncologist and your primary care physician. 
    • Keep all appointments noted in the follow-up plan. There is reason each one is there. "Feeling great without symptoms" is not a reason to miss a follow up appointment (nor is a symptom you fear may be a recurrence).
  • Consider:
    • Taking supplements to make up for any nutrients you are not getting in your regular diet. Your doctor or a dietitian/nutritionist may have suggestions about which supplements to take, if any. 
    • Hormonal therapies to prevent a recurrence.
    • Gene testing to decide whether to take additional steps.
  • Adopt a cancer prevention lifestyle. For instance:
    • If you smoke quit. It helps reduce the odds that cancer will reappear. You’ll also reduce your risk of heart disease and other smoking related illnesses.
    • if you are overweight, lose the extra weight.
• Comply with drug regimens. Save money when purchasing drugs. Store and dispose of drugs safely.
• Prepare for visits with your doctors. 
  • Keep track of your symptoms, if any. Survivorship A to Z provides a Symptoms Diary to help. (A push of a button turns it into an easy-to-read graph to save precious time with your doctor).
  • Keep an ongoing list of questions and concerns so you don't have to try to remember things when you're under the pressure of a short period of time with the doctor. Survivorship A to Z provides a Prioritizer to help.
• Take care of your mouth. An infection could spread throughout your body.
• Consider getting a pet.if you do not have one. Studies show they can help quality of life and possibly even the length of life.
• Be sure there is  humor in your life - preferably on a daily basis.
• If your relationship with your doctor is not ideal, try to fix it. If it becomes difficult for you, consider looking for another doctor.
• Now that you’ve been dealing with the medical system and hopefully recognize how helpful knowledge is to getting what you need, take a few moments to think about what to do if there is a medical emergency, or how to continue medical care if there is a disaster. In case you need it in the future, keep in mind that We provide information about how to maximize time in a hospital, including staying safe. To learn more, click here. 
• If you haven’t already, now is the time to assure that you keep control of your medical care even if something happens and you become unable to speak for yourself. The documents you’ll need to think about are called Advance Healthcare Directives and Advance Mental Health Directives. They’re free and easy to execute. We provide an article showing how to enforce directives. 
• While you’re at it, write a Will if you don’t have one, or check your existing will to be sure it is up-to-date. Survivorship A to Z even has information about how to make sure your will is challenge proof.
• Although treatment may be over, medical expenses may linger or new ones may be incurred. To learn techniques for coping with financial issues, see: How to Maximize Use Of Your Health Insurance, Breast Cancer Finances and How To Deal With A Financial Crunch.

There are likely to be follow up visits with each of your oncologists. There are usually also periodic imaging tests.

Show up for all follow-up appointments and tests.

As with all doctor appointments, it is advisable to prepare for your appointments. For instance:

• Keep track of your symptoms, if any. (We provide a Symptoms Diary to make it easier).
• Keep track of questions as they arise so you don't forget them. (You can do that on our Prioritizer. Then, before you go to the appointment, you can reorder your questions to your priority with the click of a button).
• Take blood tests and imaging scan tests prior to the meeting so you can go over the results while you are with the doctor.
• If you haven't already, learn how to maximize your time with your doctor.

Depending on what works for you, consider seeing all your doctors on one day, or purposefully spreading visits so you have set occasions to ask questions and talk about symptoms that don’t seem serious enough for an immediate call.

Ask each doctor what to look for which would trigger an immediate phone call.

Figure out which of your doctors to call about what.

Decide which of your doctors is in charge of your overall health. It could be your primary care doctor, your gynecologist or one of your oncologists. Be sure he or she agrees to the position. Make sure all doctors report notes about each appointment to your primary doctor. Remind each doctor you see after each visit to report notes about each appointment to your primary doctor. If you are keeping your own journal (which we recommend that you do), a copy should be sent to you as well.

If you do not like your experience with your oncologist, and can’t get over glitches in your relationship, consider changing doctors. Your oncologist will be in your life for a long time – possibly for the rest of your life.

NOTE: It is advisable to keep your own copy of your medical records for future reference and in case you see a new doctor. If you haven’t done it before, get a copy and put it in your files. Start keeping it to date.

It is possible that the physical and mental effects of chemotherapy or radiation will continue for quite a while - or new symptoms may show up. For example:

• If you had radiation or chemotherapy, fatigue may persist. 
• Depression may be ongoing or recurrent. The severity, and how long they continue, varies from person to person.
• You may even experience post traumatic stress disorder or peripheral neuropathy (a tingling or pain in your hands or feet).
• If you had chemotherapy, it is not unusual for a reaction known as "chemo brain" to continue or even to show up after treatment ends.
• If you had radiation, a condition known as “radiation recall” may appear.

Continue the techniques that worked to combat side effects during treatment. If they' stop being effective, consider using other methods. They are described in:

• Chemo Brain 101
• Fatigue: Cancer Fatigue
• Lymphedema
• Neuropathy (Nervous System Changes)
• Sleep

If any lingering effects interfere with your life or seem severe, contact your cancer doctor or other health care provider.

NOTE: 

• Report changes or new symptoms to your doctor.
• If you experience fatigue, work with your doctor to try to determine the cause. For example, fatigue could be a symptom of:
  • Depression: A psychologist can help improve functioning, especially one knowledgeable about the impact of cancer on someone's life. Psychotropic medication may also help.
  • Hypothyroidism: Thyroid tests usually done routinely may not be specific enough for people with cancer treatment in their medical history. If thyroid problems are suspected, a specialist known as an endocrinologist will be able to accurately diagnose and treat them.
  • Anemia: A simple blood test can determine iron deficiency anemia. Some people may need iron supplementation. A change in eating habits may help.
  • Heart problems.

If your tumor was estrogen-receptor-positive, it is likely that your cancer doctor will recommend that you start hormonal therapy.

Hormonal therapies are systemic treatments. They treat the whole body. For women who are estrogen-receptor-positive, estrogen stimulates the growth of cancer cells. Hormonal therapies aim to reduce or eliminate the possibility that estrogen will gain access to any cancer cells.

Tamoxifen has historically been the most commonly prescribed hormonal therapy but there are other treatments to consider. Discuss the pros and cons of each treatment with your cancer doctor. He or she will alert you to side effects to watch for and tips for coping with each.

To learn more about hormone therapies, see the American Cancer Society .

A cancer follow-up plan describes your diagnosis and treatment. It also tells you and your non-cancer doctors signs to look for that could be a long term result of your treatment or a return of your breast cancer, and when to do which follow-up exams. 

It is recommended that every cancer survivor have a cancer follow-up plan. For example, it is generally recommended that women who have had breast cancer:

• See their surgeon or medical oncologist for an examination and to discuss potential signs of recurrence:
  • Every three to six months for the first three years after breast cancer treatment
  • Every 6 to 12 months in the fourth and fifth years after treatment
  • Once a year after five years.
• Continue to conduct breast self-exams monthly
• Undergo a yearly mammogram and pelvic exam
• Be screened for other cancers

Some of the signs to watch for are: a persistent cough, changes in the chest wall or breast, weight loss, swelling or other changes in the lymph nodes, heart or lung symptoms, vaginal bleeding, or muskoskeletal pain.

According to Johns Hopkins Medicine, routine radiologic studies (such as bone scanning and chest radiography) and laboratory tests (such as complete blood counts and liver function tests) are not recommended for women who do not have symptoms of a recurrence.

If you do not have one, get a cancer follow up plan from your cancer doctor or from a nearby Survivor clinic at an NCI certified cancer center. You can locate an NCI certified cancer center at: cissecure.nci.nih.gov/factsheet. Your insurance is likely to cover these services.

Ask your cancer doctor when to call if any of the symptoms you have been warned about appear, or if other symptoms show up.

• Do not be surprised if the doctor uses a two week rule in some instances: if a symptom continues for two weeks, call. 
• If a symptom interferes with your daily life, call right away.

NOTE: Report all unanticipated changes in your health to primary care physician as well as to your oncologist. The symptoms could relate to your breast cancer, or to something else entirely.  An update by fax or email will do.   

Treatment for breast cancer is frequently followed by a regimen of chemopreventive substances that can help prevent or delay a recurrence of your cancer or development of another cancer. For example, Tamoxoxifen may be prescribed for up to 5 years after the end of breast cancer treatment.

You may also be given other prescriptions for drugs from time to time.

It is important to follow the doctor's orders both as to how to take the drugs and for how long. This is known as "adherence" or "compliance."  Over the long haul, some people associate continuing to take medications with their disease. They stop taking their meds to put the entire episode behind them. It is better to think of each pill you take as part of your commitment to do what you can to maximize your health.

To learn how to follow drug regimens see: Drug Compliance: Why And How To Take Drugs As Prescribed

For a discussion of how to buy drugs, (even if you cannot afford them) and how to live with them, see  Choose, Buy, Store, And Live With Drugs And Supplements Wisely 

• Before agreeing to take any drug, learn about the risks as well as the benefits.
  • Survivorship A to Z provides questions to ask before agreeing to take any drug. 
• Do what you can to avoid medical errors
  • Start by obtaining a readable doctor’s prescription. If you can't read it, the odds are that the pharmacist can't either.
  • Check the drug you receive against the prescription and make sure it looks like you expect. Speak up if it doesn't look right or if you have a question.
• Avoid overmedication. 
  • Overmedication is all too common. 
  • Ask your doctor if a lower dose will do the same job - particularly for drugs you continue to take over time.
• Carry a list of your drugs all the time. 
  • Emergencies happen. 
  • Plus the list will be helpful each time you see a doctor or fill a prescription. 
  • Survivorship A to Z provides a form List Of Medications).
• Have each newly prescribed drug checked for negative interaction with other drugs you are taking . Do not assume that this will happen automatically. 
• Over-the-counter medications are drugs and have to be treated that way.
  • Just because over-the-counter medications are sold without a prescription does not mean that there is no risk.
• Take care if you use herbs, vitamins or other supplements.
  • They are not subject to FDA approval. Therefore, there is no guarantee about their safety or effectiveness. 
  • There is not even a guarantee that the same mix of ingredients will be in each bottle – even for bottles from the same manufacturer.
• Consider price, even if you have health insurance. It may feel like insurance company money is other people's money, but expenses will eventually show up in increased premiums. See: Drugs: How To Save Money When Buying Or Using
• Do not let price be the sole factor in determining what you want or where to obtain a drug. For example, consider:
  • What happens if you need a refill in an emergency? 
  • Also keep in mind that a pharmacist can be a very important part of your health care team.  
  • If necessary, you may be able to obtain drugs for free or very low cost.
• Help is available if you cannot afford prescribed drugs.
• If a health insurer declines to pay for use of a drug because it is "off label" (a use other then the use approved by the FDA), appeal with your doctor's help. Be persistent. Depending on which study you read, between 50 and 75 percent of cancer drugs are prescribed off label.
• If the current drugs on the market do not satisfy your needs, there may be newer drugs to consider that are still being tested for safety. Access to these drugs is through clinical trials – controlled tests where use of the drug is medically monitored. It is essential that you be fully informed before entering a clinical trial.
• Live with drugs wisely.
  • Comply with prescribed orders. Non-compliance can be harmful. Time tested tips help if you have difficulty complying.
  • Do not share drugs.
  • Store drugs correctly. For example, in a cool dry place. Nnot in a medicine cabinet in the bathroom.
• Travel well with your drugs. 
  • Carry a copy of your prescription. 
  • Carry an extra supply in case you get delayed.
  • Keep drugs in their original bottle which has your name on it
• Stay open. Keep in mind that the decisions you make regarding medical care and treatment may change over time.

There are two genes which increase the risk of breast cancer returning. If you have not been tested, speak with your oncologist about whether to do do gene testing. If you have the gene, you may want to consider taking such steps as having a bilateral mastectomy (having both breasts removed).

According to the American Cancer Society: Doctors will sometimes suggest patients have genetic testing if others in their family have had a certain disease. If you have any of the following, you might consider genetic testing for yourself:

• Several first-degree relatives (mother, father, sister, brother) with cancer, especially the same type of cancer.
• Family members who developed cancer at a young age.
• Close relatives with rare cancers.
• A known genetic mutation in the family (from one or more family members who had genetic testing).

The American Cancer Society has an extensive discussion about gene therapy, including what genetic testing is, who should get it, payment, what happens during the process (including counseling), and what to do if the test shows you have an increased risk. To learn more, click here.

Inections in your mouth can quickly spread throughout your body. Chemotherapy may increase the risk for decay.

Practice good oral hygiene.

• Brush your teeth after every meal with a soft toothbrush and at bedtime. 
• Use a toothpaste with flouride in it. 
• Floss at least once a day.

If You Are Overweight, Lose The Extra Weight

Consider Complementary Treatments

Think About What To Do In Event Of A Medical Emergency