What You Need to Know About the New Guidelines for Breast Cancer Survivors
The ACA encourages breast cancer survivors to take charge of their health with good nutrition, physical activity, weight control, and smoking cessation. (Shutterstock)
Nearly a quarter of a million women in the United States will receive a diagnosis of invasive breast cancer in 2015, according to American Cancer Society (ACS) estimates, but the vast majority of them will survive — and continue to need care for the rest of their lives that takes into account their history of breast cancer.
A new set of guidelines released by the ACS comprehensively addresses the care women will need for every aspect of their health once their bodies no longer show evidence of disease from breast cancer.
The “Breast Cancer Survivorship Care Guideline” published in early December in CA: A Cancer Journal for Clinicians addresses screening for cancer recurrence as well as women’s bone health, pain management, cognitive impairment risk, mental and behavioral health, fertility concerns, sexual health, lifestyle recommendations, nutrition, heart health, and menopause, among other areas.
“There are quality-of-life issues that are important, because most women with breast cancer do not die,” says the guideline’s lead author, Carolyn D. Runowicz, MD, professor of obstetrics and gynecology at the Herbert Wertheim College of Medicine at Florida International University in Miami. “It covers the entire waterfront of issues that affect a woman,” adds Dr. Runowicz, a breast cancer survivor herself.
To come up with the guidelines, a group of experts from primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing reviewed more than 1,000 articles that focus on evidence related to breast cancer survivors’ health care. Ultimately, the group pulled together recommendations from 237 of those articles.
“The new guidelines for managing breast cancer survivors are actually not new, but do offer the clinician a very specific and complete management strategy for the many women who are surviving after treatment of their breast cancer,” says Lauren Cassell, MD, chief of breast surgery at Lenox Hill Hospital in New York City, who was not involved in creating the guidelines.
“It is a rational approach to providing the best and most comprehensive care, particularly if the patient will be returning to her primary-care physician for continued follow-up. The goal is to provide them with the best quality of life, avoid overtesting where not indicated, and help them maintain a healthy lifestyle.”
Maintaining Healthy Behaviors for Life
A significant proportion of the recommendations focuses on nutrition, physical activity, obesity risk, and quitting smoking, when relevant.
“We know women who are overweight are at a higher risk for cancer,” Runowicz says. “Maintaining an ideal body weight is really the driving force behind a healthy lifestyle. You really have to restrict your calories, eat good food rather than empty calories, and keep moving — get out there and exercise. It’s good for your bones, it’s good for your weight, and it’s a fact of life,” she adds.
Body Weight and Menopause. Maintaining a healthy body weight can become even more challenging during menopause, Runowicz acknowledges.
“All of the issues of menopause are covered in this article, including hot flashes, body image changes, sexuality, and potentially painful intercourse,” Runowicz says. “We know that in menopause, women gain weight, and it’s a very difficult issue to deal with.”
Weight gain in menopause appears linked to the lack of estrogen in women, but for survivors of breast cancer, a drop in estrogen levels is a good thing, Runowicz says. “No matter how debilitating the hot flashes are, women will try whatever they can before taking hormone treatment,” she says.
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Body Image Concerns. Some women may have concerns about body image to work through once cancer treatment is over. Exercise, along with yoga and meditation, can help in this area by improving a woman’s overall sense of well-being. But sometimes more is needed.
“The body image issue is such a personal thing and very complicated,” Runowicz says. “I never want to make a woman feel that because she had a mastectomy, she needs a prosthesis or reconstructive surgery — so you don’t want to give a woman an image problem if she doesn’t have it. But if she seems to be struggling, you can usually ask in an indirect way.”
Similarly, Runowicz asks indirect questions that can help her discover whether a woman is struggling with her sex life, a possible indication of body image problems, relationship problems, or pain during intercourse. She can also often pick up on whether women might want to consider counseling from a mental health professional.
“It’s very traumatizing having chemotherapy and facing your own mortality, so the spectrum of reactions is huge,” Runowicz says. “What I think a patient needs to do is take a mirror and see what she’s seeing in the mirror and address those issues head-on.”
Managing Long-Term Health
In addition to recommendations related to a healthy lifestyle, the guidelines address managing long-term physical and mental effects from cancer treatment, including chemotherapy, radiation, and surgery.
“I think that the most important thing is that the patient empowers herself and takes a few proactive measures,” Runowicz says. “That would include making sure she has a treatment summary of her surgery, her radiation, or her chemotherapy, because it’s critical that she knows and can communicate what she’s had to either her primary-care doctor or her oncologist if she moves to another city or state and needs a new oncologist. Having that record is a critical step in empowering a patient who is now becoming a cancer survivor.”
Ongoing Cancer Screenings. The guidelines also recommend that women undergo regular surveillance for breast cancer recurrence, as well as screening for new primary breast cancer and other types of cancer. For example, women should follow the guidelines for cervical, colorectal, endometrial, and lung cancer screening.
But the evidence does not support routine lab or imaging tests in women who do not have symptoms of recurrence, which is often the top worry for survivors, Runowicz says.
“The guidelines are very clear about when to get a mammogram, if you’re eligible for an MRI, and whether you should be genetically counseled and tested,” Runowicz says. MRIs are more accurate than mammograms for those with genetic mutations, such as BRCA genes, linked to breast cancer, she explains.
Exceptions to the Rules. “In spite of the guidelines, each patient has to be approached as an individual who may require certain deviations from these guidelines based on her specific history and needs,” Cassell points out.
“Many of these women will be receiving treatment for hormone receptor-positive tumors, which can have significant side effects,” she says. “It is important that the clinician recognize and deal with them so that the patient remains compliant with her treatment.”
For example, women who took Adriamycin (doxorubicin) as part of their chemotherapy regime have an increased risk of heart complications, and knowing that can help those women ensure they get appropriate care, Runowicz says.
Self-Empowerment Is Key. “There are ways a patient can really empower herself in terms of what she needs and become a partner with her doctor instead of somebody who just listens to whatever the doctor says,” Runowicz says. “That’s a critical piece of the guidelines, that they empower patients to be active participants in their healthcare. If they move to getting care from their primary-care doctor, it’s important to know what to ask for.”
This article originally appeared on EverydayHealth.com: New Guidelines for Breast Cancer Survivors
By Tara Haelle, Everyday Health
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