Breast Cancer treatment

As a breast cancer patient, it may seem that you're faced with an endless series of tests. Some are innocuous but necessary to determine how well the body is handling treatment. Other tests are much more nerve-wracking, such as your first mammogram 6 months after treatment ends.
Here's a rundown of the tests you can anticipate both during and after treatment:
During Treatment
While you are undergoing treatment, your doctor will order regular complete blood count tests (CBC). This sounds a little daunting, but don't worry -- it usually involves just one needle stick.
A CBC is a very broad screening test, which provides your physician with a wealth of information. For women undergoing chemotherapy or radiation, the physician will likely focus on the following aspects of the test:

• White blood cell count: Both radiation and chemotherapy can lower your white blood cell count, make you more susceptible to infection and disease.
• Hematocrit/Hemoglobin: This test, also part of the CBC, are measures of red blood cell quantity. Red blood cells transport oxygen to the body. If these count are low, your physician may diagnose you with anemia. There are several types of anemia, but the condition typically causes weakness, fatigue and, in some cases, concentration problems. Anemia is rarely a significant health problem for those undergoing cancer treatment, but the symptoms can impact daily life. Other bits of information from the CBC can help a physician diagnose specific types of anemia or even vitamin deficiencies. During treatment, a high hematocrit level might also indicate dehydration.

The frequency of your CBC tests will depend on your doctor's preferences and the chemotherapy drugs you'll be using. If you haven't had a lumpectomy or mastectomy, your physician may also recommend ultrasound, MRI or mammography to assess how well a tumor is responding to treatment. Be sure to talk to your physician about how she or he plans to monitor your progress.
After Treatment
According to the American Cancer Society, your physician will probably schedule follow-up appointments every 4 to 6 months.
What happens during these visits will depend greatly on your treatment plan. For example, patients using an aromatase inhibitor, which reduces the amount of estrogen in the body, can sometimes experience a reduction in bone density, so your physician might recommend an annual bone density scan.
In addition, your physician will likely respond to any symptoms you experience by ordering additional tests, for example, of liver function, heart function or kidney function.
Tests such as a chest x-ray, an MRI or a CT scan generally won't be recommended unless symptoms or other test results indicate a need. If symptoms or other tests warrant it, your physician might recommend blood tumor marker tests, which can indicate if cancer has spread, or metastasized, to the bones or other organs. Keep mind, however, that tumor marker tests can only identify the small number of cancers that produce specific proteins that the tests measure.
Mammography
There's no clear consensus on mammography guidelines for women who've completed breast cancer treatment. In fact, a study published in the 2006 journal Breast Cancer Research and Treatment reported that less than a fifth of such women were told to have a mammogram 6 months after finishing their treatment.
The American Cancer Society recommends different mammogram schedules, depending on the initial treatment selected. These schedules apply to the affected breast only. Women should pursue annual mammograms on an unaffected breast.

• After breast-conserving surgery: Breast-conserving surgery is commonly combined with radiation therapy. Because changes in the breast tissue due to radiation typically peak at about 6 months after treatment, patients should have their initial mammogram 6 months after completing radiation therapy. Beyond the initial mammogram, expert opinions vary. Some experts recommend mammograms every 6 months for 2 to 3 years. Others advise patients to simply have annual mammograms.
• After mastectomy, without any breast tissue remaining: According to the American Cancer Society, women who've had radical, modified radical or total mastectomy don't need regular mammography on the affected side. These types of surgery typically remove all of the breast tissue. Talk to your doctor if you aren't sure if you have any remaining breast tissue on your affected side.
• After mastectomy, with remaining breast tissue: If you opted for a mastectomy that preserved any original breast tissue, physicians recommend a bi-annual mammogram on the affected side for two to three years after treatment. At that point, women should pursue an annual mammography schedule.

Some physicians also incorporate MRI into the breast cancer screening processes, particularly for women with dense breasts or those with a gene mutation that makes them more likely to develop breast and ovarian cancer. Talk to your doctor about his or her recommendations regarding MRI.
Clinical Breast Exams
Here, too, physicians differ. There's no single view on the subject of clinical breast exams for women who've been treated for breast cancer. Ask your doctor about his or her recommendations and be sure to request a clinical breast exam during your annual visit.