Guidelines recommend that after treatment for breast cancer you should have a yearly mammogram and regular check-ups. This usually means 3-6 monthly appointments. At these appointments your specialist will examine you and ask you how you are feeling and if there has been anything troubling you. Other tests, such as blood tests for tumour markers, will usually only be done if you have symptoms that need to be investigated.

Tumour markers are proteins that may be found at higher levels in the blood when a cancer is present. When you are diagnosed with breast cancer a blood test may be done to check for tumour markers. Although, some doctors check the levels of tumour markers in the blood as part of routine check-ups after treatment, there isn't clear evidence that this is helpful. So, there aren't guidelines to say how often these should be done.

There are several tumour markers for breast cancer but the ones most commonly used are CEA and CA15.3. After your treatment is over, if CEA or CA15.3 levels begin to go up this may be an early sign that breast cancer has come back and is beginning to grow. CEA and CA15-3 levels don't tend to rise if the cancer comes back in or around the breast area. They seem more sensitive at picking up early signs of cancer that has spread to other parts of the body such as the bones or liver. However, guidelines don't recommend using tumour markers as part of routine follow up for breast cancer.

This is because:

• A raised level of CEA or CA15.3 isn't always a sign of cancer coming back. Sometimes levels can be raised for other reasons and levels may rise and fall making the results difficult to interpret. So, regular testing can cause unnecessary upset and anxiety for women.
• Monitoring CEA and CA15.3 levels can sometimes detect if a breast cancer has come back (recurrence) before other tests can. But this is only helpful if it leads an improved survival or quality of life for women. Overall, the studies that have looked at using tumour markers as part of routine follow up haven't been able to show women benefit in either of these ways. Instead they found that regular follow up with mammograms and specialist check-ups worked just as well.

References

• SIGN 2005. Management of Breast Cancer in Women.
• Rojas et al 2000. Follow up strategies for women treated for early breast cancer. Cochrane Database of Systematic Reviews.