Breast cancer can return years later

Dear Dr. Roach: Sixteen years ago, at age 56, I was diagnosed with Stage 3 HR+ breast cancer. I was treated with a modified radical mastectomy, followed by chemotherapy, six weeks of radiation, then about seven years of oral anti-estrogen drugs.

My primary care doctor retired last fall. While looking for a new one, I went to my cardiologist who saw that a chest CT two years earlier showed two small lung nodules. She felt that a follow-up was needed, so she ordered it. The followup CT showed multiple small lung lesions and a new nodule in the liver, but the radiology report included the statement that low-risk patients required no follow-up.

It took six months to get a new primary care doctor, and when I shared that I had some concerns about the findings on my scan, she read the report and said, “It says right here that low risk patients need no follow up, so don’t worry about it.”

I read a recent study with a very large number of participants that showed recurrence rates as high as 15% to 20 % in patients up to 30 years after treatment. My cardiologist was very upset by the new doctor’s response, but says she “cannot assume the responsibility.” She gave me names of other primary care doctors she highly recommends.

This all leaves me a bit confused. My oncologist’s office informed me that they do not do any diagnostic work, and only treat once a cancer is diagnosed. They told me my primary care doctor should instruct me as to what to do. Should I find a new doctor?

K.B.

Answer: I am disappointed in the responses by your primary care doctor and oncologist. You should have had, at a minimum, a physical exam and scrutiny of the CT scans to see whether these lesions and liver nodule are compatible with breast cancer. If they are, your doctors should consider a biopsy. You deserve a doctor who will take this seriously, and not immediately dismiss you as “low risk.” You are absolutely right that breast cancer can recur after many years. Even “low risk” breast cancer can come back. Patients and physicians need to stay vigilant.