Patient Letter

Dear Patient:

As you have completed your treatment for breast cancer, your care is being transferred from the Cancer Center back to your family doctor. We have sent a letter to your family doctor (as recorded on your last visit) advising that you have been discharged from the Cancer Clinic.

It is your responsibility to contact your doctor and arrange for your own follow-up visits.

If you do not currently have a family doctor, please call your health region office or Health Link Alberta (1-866-408-5465) for a list of doctors in your area.

Our standard follow-up recommendations are as follows:

For everyone after breast cancer treatment:

Examination by your family physician every 6 months for 2 years, and then annually,
Annual mammography (which may be performed at the Cancer Center or at any other accredited mammography facility),
Breast and axilla (armpit) self-examination (both sides) each month,
If you are not having any symptoms that your doctor is concerned about, we wo not recommend regular chest X-rays, bone scans, ultrasounds of the abdomen or lab tests as routine follow-up.

For people receiving tamoxifen therapy:

if you experience abnormal vaginal bleeding and/or a swollen leg, please contact your family physician immediately.

For people receiving aromatase inhibitor therapy (e.g.: anastrozole/Arimidex, exemestane/Aromasin, letrozole/Femara):

Aromatase inhibitors may cause your bones to thin (osteopenia or osteoporosis), increasing the risk of breakage (fracture). You should see your doctor to schedule regular bone mineral density testing.
It is recommended that women who have gone through menopause exercise regularly and take both calcium (1000 to 1500 mg daily) and Vitamin D (800 - 1000 IU daily) to help maintain bone strength.
Additional medications may be prescribed (such as bisphosphonates) if you are diagnosed with thin bones or are at risk for bone fracture (osteopenia or osteoporosis).
Raloxifene (Evista) is not recommended for treatment of osteoporosis in patients with a previous breast cancer diagnosis.

When booking your appointment with your doctor's office, be sure that

enough time is scheduled for your examination.

Report any new breast lumps, persistent bone pain, shortness of breath, arm/leg swelling or abnormal vaginal bleeding to your doctor. While these may be related to your cancer history, remember that a variety of other things may also cause similar symptoms.

If you are receiving anti-hormonal treatment (tamoxifen or aromatase

inhibitors), the Cancer Center Pharmacy will provide these medications (free of

charge) with a prescription from your family doctor. Please present your

prescription to the Cancer Centre Pharmacy or ask your doctor's office to fax it

to the Cancer Center Pharmacy.

If you have access to the Internet, you are welcome to view the Canadian

recommendations for follow-up care, entitled "Clinical practise guidelines for the

care and treatment of breast cancer: follow-up after treatment for breast

cancer (summary of the 2005 update)" published in the Canadian Medical

Association Journal at http://www.cmaj.ca/cgi/content/full/172/10/1319/DC1/.

You are still a registered patient at the Cancer Center. Your discharge from the Cancer Center means that we feel you are doing well. If there are any concerns regarding cancer recurrence, your doctor will refer you back here for consultation.

Thank you for letting us be part of your healthcare team,

Alberta Breast Cancer Program Team

If you have access to the Internet, you may find the following links useful:

Alberta Cancer Board: http://www.cancerboard.ab.ca/

Canadian Cancer Society: http://www.cancer.ca

American Society of Clinical Oncology: http://www.plwc.org (patient information site)

Osteoporosis Society of Canada Web Site: http://www.osteoporosis.ca