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Breast Cancer Screening Guidelines
Ernest H. Rosenbaum, MD

Years after radiation therapy, a small percentage of patients have angiosarcomas, and after chemotherapy, myeloid leukemia and uterine carcinoma - often as a side effect of Tamoxifen treatments, which results in estrogen-agonistic effects. The incidence is low - less than 1% in five years - and routine screening is not indicated. For pelvic transvaginal ultrasonography in asymptomatic women on Tamoxifen, there's a false positive rate of 20%, as Tamoxifen does cause benign endometrial thickening, polyps, and other abnormalities. If there's vaginal bleeding, an assessment is recommended.

1. Periodic history and physical examination every four to six months in the first year and then annually if not receiving therapy.
2. Yearly mammogram.
3. Symptom education of potential recurrence, especially for those taking Tamoxifen - signs and symptoms of uterine cancer.
4. Treatment for osteoporosis, if indicated, and use of vitamin D and calcium is a good policy.

The use of bisphosphonates has some limited evidence as an anti-breast cancer recurrence drug. There are some suggestions that it might even increase survival.

Extended treatments, such as five years of Tamoxifen and five years of aromatase inhibitor is under investigation.

Women who have premature menopause due to anti-estrogen therapy or adjuvant therapy may need psychological support and careful follow-up. Estrogen therapy is avoided.

Depression is often a problem seen in between 20-30% of cancer patients, and psychological supportive therapy and drug therapy are helpful. Counseling and potential therapeutic interventions for sexual dysfunction are merited, especially if there is vaginal dryness, and the use of non-hormonal preparations or cautious use of the estrogen ring preparations is merited. Treatment for osteopenia and osteoporosis with calcium and vitamin D, weight-bearing exercises and bisphosphonates, if indicated, can be helpful.



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