Breast Cancer Survivorship

Breast cancer remains the most common type of cancer among Canadian women, with 28,900 new cases in 2022 alone. Improved detection through screening mammography and advances in multi-modality therapy account for the decline in breast cancer mortality seen in Canada since the 1980s. As 5-year survival rates reach 89%, the number of breast cancer survivors is rising. The concept of cancer survivorship has existed for decades, as has the appreciation that it is a complex domain of cancer care that begins at the time of diagnosis. Even within the group of patients with breast cancer, survivorship experiences and care needs are diverse, reflecting variability in tumour clinicopathologic characteristics, treatment plans, and prognosis. Evidence-based tools and guidelines suggest the assessment and management of cancer survivor’s physical, psychological, social, financial, and employment well-being. There is a need to clinically monitor for breast cancer recurrence and the development of secondary malignancies through screening. Survivorship also warrants attention to health promotion, including weight management, nutrition, physical activity, preventive health, and cessation of alcohol and cigarettes. The provision of survivorship care is the responsibility of all healthcare professionals, which requires close coordination between primary care and specialized cancer centres. In this article, we focus on the physical and psychosocial long-term and late effects faced by survivors of early-stage breast cancer. Many adjuvant therapies for breast cancer are associated with toxicities that negatively impact quality of life (QoL) and adherence. Nonadherence is important to address because it compromises breast cancer outcomes.