title: Follow-up after treatment for breast cancer: Practical guide to survivorship care for family physicians.
abstract: OBJECTIVE
  To offer FPs a summary of evidence-based recommendations to guide their follow-up survivorship care of women treated for breast cancer.
  
  
  METHODS
  A literature search was conducted in MEDLINE from 2000 to 2016 using the search words breast cancer, survivorship, follow-up care, aftercare, guidelines, and survivorship care plans, with a focus on review of recent guidelines published by national cancer organizations. Evidence ranges from level I to level III.
  
  
  RESULTS
  Survivorship care involves 4 main tasks: surveillance and screening, management of long-term effects, health promotion, and care coordination. Surveillance for recurrence involves only annual mammography, and screening for other cancers should be done according to population guidelines. Management of the long-term effects of cancer and its treatment addresses common issues of pain, fatigue, lymphedema, distress, and medication side effects, as well as longer-term concerns for cardiac and bone health. Health promotion emphasizes the benefits of active lifestyle change in cancer survivors, with an emphasis on physical activity. Survivorship care is enhanced by the involvement of various health professionals and services, and FPs play an important role in care coordination.
  
  
  CONCLUSIONS
  Family physicians are increasingly the main providers of follow-up care after breast cancer treatment. Breast cancer should be viewed as a chronic medical condition even in women who remain disease free, and patients benefit from the approach afforded other chronic conditions in primary care.
authors.affiliation: Chair of the College of Family Physicians of Canada's Cancer Care Program of the Section of Communities of Practice in Family Medicine and Vice-Dean of the Office of Continuing Competency and Assessment in the Faculty of Health Sciences and Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg. jeff.sisler@umanitoba.ca.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sisler
authors.affiliation: Attending family physician at McGill University Health Centre in Montreal, Que, leading their Cancer Survivorship Program, a member of the Cancer Care Program committee of the College of Family Physicians of Canada, and a member of the Canadian Partnership Against Cancer's primary care working group.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Chaput
authors.affiliation: Radiation oncologist and a health services researcher in Hamilton, Ont, and Chair of the Advisory Committee on Survivorship for Cancer Care Ontario.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sussman
authors.affiliation: Project Manager for the Integrating Primary Care and Cancer Care in Survivorship initiative at CancerCare Manitoba in Winnipeg.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ozokwelu
mesh_terms: D000359:Aftercare / Q000592:standards*; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D010821:Physicians, Family / Q000592:standards*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate