TABLE 3-3 Possible Late Effects Among Breast Cancer Survivors

Late Effect

Population at Risk

Risk

Interventions

Cancer recurrence

All women with a history of breast cancer

Varies by stage and tumor characteristics

Mammography, physical examination

Second primary cancer

All women with a history of breast cancer

Varies by treatment, age, and genetic predisposition (women with BRCAa mutations are at higher risk)

Mammography, pelvic examination, general physical examination, patient education

Psychosocial distress

All women with a history of breast cancer

Approximately 30 percent experience distress at some point; distress declines over time

Assessment for distress

Some psychosocial interventions are effective in reducing distress

Arm lymphedema

Women who had axillary dissection and/or radiation therapy

Across treatments and time since treatment, approximately 12 to 25 percent of women develop lymphedema

Massage and exercise (manual lymphatic drainage), use of elastic compression garments, complex decongestive therapy

Premature menopause and related infertility and osteoporosis

Women who received adjuvant chemotherapy (e.g., alkylating agents such as cyclophosphamide)

Women with BRCA mutations who elect oopherectomy

Risk depends on the chemotherapy regimen, the cumulative dose, and patient age (see details below)

New reproductive technologies for infertility

Diagnostic and preventive strategies for osteoporosis

Assessment of sexual function

Symptoms of estrogen deprivation (e.g., hot flashes, sweats, vaginal discharge)

Women taking endocrine therapy

More than half report symptoms, although mild in most cases

Promising nonhormone treatments include antidepressants, dietary changes. and exercise



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