Clinical evaluation of women previously treated for breast cancer: an algorithm for the primary care physician

Breast cancer is an extremely prevalent disease that is estimated to affect one of every nine women, as predicted by lifetime risk in the year 2002. Diagnostic efforts to detect early disease and therapeutic advances including adjuvant therapies have contributed to an increased 5-year survival rate. Therefore, a gynecologist must be prepared for the diagnosis and treatment of typical sequelae after the treatment of breast cancer, as well as aware of health maintenance guidelines particular to this patient group. There are both intrinsic sequelae of breast cancer and side effects of breast cancer treatment, including depression, decrease of libido, vasomotor complaints, vaginal symptoms, and mechanical issues secondary to surgery. Additionally, the primary care physician must consider long-term health consequences of low estrogen states in women who experience menopause as a result of chemotherapy and adjuvant therapies such as aromatase inhibitors. There is need for an algorithm to direct continuing care by the primary care physician, including the gynecologist.