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World J Clin Oncol. Oct 10, 2014; 5(4): 693-704
Published online Oct 10, 2014. doi: 10.5306/wjco.v5.i4.693
Caring for the breast cancer survivor’s health and well-being
Petra M Casey, Stephanie S Faubion, Kathy L MacLaughlin, Margaret E Long, Sandhya Pruthi
Petra M Casey, Margaret E Long, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, United States
Stephanie S Faubion, Women’s Health Clinic, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Kathy L MacLaughlin, Department of Family Medicine, Mayo Clinic, Rochester, MN 55905, United States
Sandhya Pruthi, Department of Internal Medicine and Breast Clinic, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: All authors contributed substantially to the conception and design of the article, acquisition of data, analysis, and interpretation of data; drafting and critical revision of the article for important intellectual content; and final approval of the submitted version.
Supported by The research grant support from Merck and certified Nexplanon
Correspondence to: Petra M Casey, MD, Associate Professor, OBGYN, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. casey.petra@mayo.edu
Telephone: +1-507-2668680 Fax: +1-507-2667953
Received: December 21, 2013
Revised: April 25, 2014
Accepted: June 10, 2014
Published online: October 10, 2014
Abstract

The breast cancer care continuum entails detection, diagnosis, treatment, and survivorship. During this time, focus on the whole woman and medical concerns beyond the breast cancer diagnosis itself is essential. In this comprehensive review, we critically review and evaluate recent evidence regarding several topics pertinent to and specific for the woman living with a prior history of breast cancer. More specifically, we discuss the most recent recommendations for contraceptive options including long-acting reversible contraception and emergency contraception, fertility and pregnancy considerations during and after breast cancer treatment, management of menopausal vasomotors symptoms and vulvovaginal atrophy which often occurs even in young women during treatment for breast cancer. The need to directly query the patient about these concerns is emphasized. Our focus is on non-systemic hormones and non-hormonal options. Our holistic approach to the care of the breast cancer survivor includes such preventive health issues as sexual and bone health,which are important in optimizing quality of life. We also discuss strategies for breast cancer recurrence surveillance in the setting of a prior breast cancer diagnosis. This review is intended for primary care practitioners as well as specialists caring for female breast cancer survivors and includes key points for evidence-based best practice recommendations.

Keywords: Breast cancer, Contraception, Vasomotor symptoms, Vulvovaginal atrophy, Sexual health, Osteopenia, Osteoporosis, Breast cancer recurrence, Breast cancer surveillance

Core tip: Caring for women with breast cancer at the time of diagnosis, during, and after treatment goes well beyond addressing the breast cancer alone. Holistic care includes safe, effective and convenient contraceptive options;local progestin intrauterine contraception may present an option for some breast cancer survivors. Discussion regarding the effects of chemotherapy on future fertility and pregnancy is an important part of survivorship care for women in child-bearing years. Addressing the effects of breast cancer treatment including vasomotor symptoms, vulvovaginal atrophy and sexual well-being is vital for all breast cancer survivors, but especially important in the setting of adjuvant therapy with aromatase inhibitors.