After someone has a bilateral mastectomy, what do they do in place of a mammogram? What sort of follow-up care is needed?

--W.O.

The follow-up needed after mastectomies depends on whether or not there were metastases to any distant organs or not. If there were metastases, then X-rays, bone scans and tests of liver function are done periodically -- and how often that needs to be done depends on the extent of the disease. If there were no metastases at the time of the original mastectomies, then usually a physical exam, blood tests, yearly chest X-ray and liver function testing will suffice.

An annual pelvic exam is crucial; breast cancer is a risk factor for ovarian cancer, and medications used to treat breast cancer and prevent recurrences -- notably tamoxifen -- may increase the risk of cancer of the uterine lining. Any abnormal bleeding in a woman on tamoxifen must be reported to the gynecologist immediately.