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“Living Your Best After Cancer: You and Your
Primary Care Doctor Working Together"
Mary Helen Hackney, MD
• Associate Professor of Hematology/Oncology at
VCU Massey Cancer Center
• Specialist in treatment for all stages of breast
• Treats cancer of all types through Massey’s
Rural Cancer Outreach Program
• Teaches residents and health professionals
about prevention, long-term patient
management and survivorship issues.
Living Your Best After Cancer: You and
Your Primary Care Doctor Working
Mary Helen Hackney, M.D.
Massey Cancer Center
Virginia Commonwealth University
• Over 10.1 million cancer survivors
• Increasing priority of many groups
including the American Society of Clinical
Oncology (ASCO)
• Be your own advocate
Taking Care of Yourself
• Establish a relationship with a general
medicine physician
Taking Care of Yourself
• Know how your cancer was treated
– Chemotherapy drugs
– Radiation therapy
– Share the information with any new health
• Ex. Bleomycin may affect lungs during anesthesia
even years out
Taking Care of Yourself
• Establish good health
– Weight control
– Exercise
–No tobacco
– No or moderate
• Different cancers have different
follow up care guidelines
– Know which apply to you
– ASCO developing guidelines
• Routine CT scans or PET
scans are not indicated for all
The Annual Physical
• Controversial: probably needs to be more
• Know your family history: not just cancer
but other diseases (cholesterol, heart
disease, diabetes, etc.)
• What should the physical include?
– Exam, lots of questions, medication review
– Selected tests
Family History
• Will help your physician know when to start
certain types of screening
• Example
– Lynch Syndrome/Hereditary Nonpolyposis
Colorectal Cancer: colon & ovarian cancer
– Diabetes in family will prompt more interest in
weight control
Do Not Smoke
Assessing the Risk
• Family genetics
– BRCA 1 and 2 (also ovary, male breast
cancer, prostate, colon ca)
– P53 (Li Fraumeni) (breast ca., brain ca.,
adrenal ca, sarcoma, leukemia)
– PTEN (Cowden’s) (thryoid ca., hamartomas,
prostate ca, breast ca.)
– Ataxia telangectasia-life time risks increased
for heterozygotes (autosomal
recessive)(breast cancer)
Breast Exam and Mammography
• Start at age 40 and then yearly
• Start earlier if family history of breast
cancer or chest irradiation
• Self breast exams monthly while in 20s
• Medical professional exam every 3 yrs in
20s, then yearly
• If you are a breast cancer survivor,
guidelines are different
(colon cancer screening)
• Start colonoscopy for screening at age 50
– Follow studies will be 3-10 years depending
on results
• Start screening earlier if family colon
cancer history or personal history of
ulcerative colitis, Crohn’s or polyp history
• Less use of stool testing, barium enema,
Gynecology Evaluation
• PAP smears recommended every three
years if normal
• Hysterectomy for benign cause: no need
for PAP smear
• HPV testing: new and under development
• If ovaries remain, then need bimanual
• If you have a cancer history, guidelines
are different
Blood Tests
Tumor Markers
• Ca 125
– Not indicated for screening
– Trial underway to assess role in high risk
• PSA (prostate specific antigen)
– Controversial: start at age 50, yearly. Start
earlier if family history or African American
• There is no perfect blood test to screen for
Other Blood Tests
• Cholesterol, lipid panel
– Esp. if over 50, diabetic, family history,
• Kidney and liver function
– Suggested for specific situations e.g. on
cholesterol medications, diabetes, etc.
• Complete blood count with white cells, red
cells and platelets
Other Health Maintenance….
• Ophthamology
– Many drugs and radiation can affect eyes
– Cataracts may worsen
Other Health Maintenance….
• Vaccinations
– Pneumovax every 5 years after splenectomy
or if over 60
– Tetanus
– Hepatitis if appropriate
– Additional vaccinations if bone marrow
No Tobacco
Continuing Health Maintenace….
• Dentist
– Many drugs affect gums and teeth
– Good oral hygiene important during and after
• Bone density
– Many chemo drugs affect bones
– Every 2 years
– Exercise, calcium, consider bisphosphonates
Taking Care of Your Health
Weight Control
No tobacco
Limit/moderate alcohol consumption
Know your past treatment history and risks
of future problems
• Development of programs to provide easy
to use/portable information packets
tailored to specific disease treatments
– May be in a electronic format
• Development of tailored treatments to
reduce risks of long term sequalae
• Increasing number of websites, journals
and information venues providing
guidance on good health for survivors
• 10 million and
• Thank you!