Screenings after cancer treatment

Two kinds of checks

Follow-up cancer care. NCI says all cancer survivors should have follow-up care: regular check-ups after treatment that may include bloodwork and other tests looking for changes in your health or problems from treatment. (NCI, follow-up)
Routine care. NCI says it is important to keep getting routine care from your primary care provider in addition to follow-up cancer care. (NCI, follow-up) The routine screenings by age are on screenings by age and gender and cancer screenings by age.

NCI says each person has a different follow-up schedule, based on the type of cancer, the treatment and your overall health. In general, people return every 3 to 4 months for the first 2 to 3 years after treatment, and once or twice a year after that. (NCI, follow-up)

Your survivorship care plan

NCI says you should receive a follow-up care plan from your oncologist or treatment team when treatment ends. Together with a summary of your treatment, it forms a survivorship care plan. (NCI, follow-up) ACS says the plan explains which screenings and checkups you need to watch for symptoms after treatment, the cancer coming back and second cancers, and should list which doctor will oversee the monitoring and order the tests. (ACS, second cancers) The ASCO plan ACS describes includes how often you should have follow-up appointments, the tests you will need and possible long-term or late effects. (ACS, care plans)

MedlinePlus says you may be given a care plan once treatment ends, and you may want to ask your doctor to make sure you receive one. (MedlinePlus) NCI suggests asking each doctor you see to send visit notes to your other doctors. (NCI, follow-up) More ideas: questions to ask your doctor.

Which routine screenings still apply

ACS says that, apart from survivors who need special screening because of family history or genetics, survivors should in general continue to follow cancer screening guidelines. (ACS, second cancers) The USPSTF recommendations, though, leave out people who already had that same cancer:

Breast. The USPSTF breast screening recommendation does not apply to people with previous breast cancer, a high-risk breast lesion on a previous biopsy, or high-dose radiation therapy to the chest at a young age. (USPSTF, 2024) See mammogram: what to expect.
Colorectal. The USPSTF recommendation is for adults at average risk, which it defines as including no prior diagnosis of colorectal cancer. (USPSTF, 2021) See colorectal screening tests compared.
Cervical. The USPSTF recommendations do not apply to people who have been diagnosed with cervical cancer or a high-grade precancerous cervical lesion. (USPSTF, 2018) See Pap smear: what to expect.

For the cancer you had, the checks are part of your follow-up care plan rather than the routine schedule. (ACS, second cancers)(NCI, late effects)

Screening for a second cancer

ACS says the risk of a second cancer is higher for people with certain types of cancer, such as leukemia or brain or spinal cord tumors, for people who had certain treatments such as radiation or chemotherapy, and for people with inherited gene changes such as BRCA1 or BRCA2. For others the risk may be lower or is not known. (ACS, second cancers) NCI says to talk with your doctor about the second cancers you may be at risk for, and to have regular check-ups for the rest of your life for the cancer you were treated for and any new cancer. (NCI, late effects) See family history and screening, BRCA test results and Lynch syndrome screening.

After childhood cancer

NCI says childhood cancer survivors should have a physical exam and medical history once a year, and that the kind of screening test depends partly on the treatment they had. For survivors who had radiation, it suggests: (NCI PDQ, childhood)

Skin. A skin exam once a year, especially where radiation was given. See skin cancer check: what to expect.
Breast, after a higher dose of chest radiation. A mammogram once a year, or a breast MRI for those with dense breasts, starting 8 years after treatment or at age 25, whichever is later.
Colorectal, after a higher dose of radiation to the abdomen, pelvis or spine. A colonoscopy every 5 years starting at age 30 or 5 years after treatment ended, whichever is later; a multitarget stool DNA test every 3 years may be done instead. See screening colonoscopy: what to expect.

Heart and bone checks

Heart

NCI says certain cancer drugs and radiation to the chest may cause heart problems that do not show up until years after treatment. (NCI, late effects) For childhood, adolescent and young adult cancer survivors treated with anthracycline chemotherapy or chest radiation, the Children's Oncology Group says: (COG, heart)

a yearly checkup with attention to any heart symptoms;
an electrocardiogram when the survivor enters long-term follow-up, usually about 2 years after treatment ends (see ECG at a checkup);
an echocardiogram or similar imaging at the first long-term follow-up visit, then repeated on a schedule that depends on the doses received, from no further scans to every 2 years;
for survivors who had radiation to the heart or nearby tissues, periodic blood tests for other heart risk factors: a lipid profile and fasting glucose or hemoglobin A1C (see cholesterol test results and A1C and blood sugar results).

The everyday heart checks for your age are on heart screenings by age.

Bone

NCI says chemotherapy, steroid medicines, hormonal therapy or radiation therapy may cause thinning of the bones, and your doctor or nurse may order tests to check your bone health at regular check-ups. (NCI, late effects) For childhood cancer survivors at risk, the Children's Oncology Group recommends a baseline bone density scan on entering long-term follow-up, 2 or more years after treatment ends, with follow-up scans for some. (COG, bone) See how often to have a bone density test.

Other late effects

NCI lists other late effects, including hearing loss after some treatments, for which it says you should have at least one visit with an audiologist after treatment, and a higher risk of cataracts after some treatments, for which it advises regular visits with an ophthalmologist. (NCI, late effects) See hearing tests by age and eye exams by age.

When to talk to a doctor

NCI says to report any problems between scheduled visits to your doctor immediately, and to tell your doctor if you notice changes in your body that last longer than a few weeks. (NCI, follow-up)(NCI, late effects) ACS lists general symptoms of a second cancer, and says to talk with your cancer care team as soon as possible if you notice any of them: (ACS, second cancers)

feeling tired;
having a sore that does not heal normally;
having a cough or hoarse voice that does not go away;
loss of appetite, difficulty digesting your food, or difficulty swallowing;
a lump, discharge, bleeding, or thickening in a certain spot;
feeling like your bones ache;
headaches and vision changes.

NCI adds that new symptoms do not necessarily mean the cancer has come back. (NCI, follow-up)

Where they differ:

Breast screening after chest radiation. The USPSTF schedule of a mammogram every 2 years from age 40 does not apply after high-dose chest radiation at a young age. (USPSTF, 2024) For childhood cancer survivors who had a higher dose of chest radiation, NCI suggests a yearly mammogram or MRI from 8 years after treatment or age 25, whichever is later. (NCI PDQ, childhood)
Colorectal screening after radiation. USPSTF average-risk screening starts at 45. (USPSTF, 2021) NCI suggests childhood cancer survivors who had a higher dose of radiation to the abdomen, pelvis or spine start at 30 or 5 years after treatment, whichever is later. (NCI PDQ, childhood)
Who sets the plan. ACS says survivors should in general keep to routine screening guidelines, (ACS, second cancers) while NCI says which tests you receive and how often is based on what your doctor thinks is best for you when creating your follow-up care plan. (NCI, follow-up)

Your doctor decides what your result means for you.

Questions people ask

Do I still need routine cancer screenings after cancer treatment?

In general, yes. The American Cancer Society says survivors should otherwise continue to follow its cancer screening guidelines, while some survivors at increased risk because of family history or genetics may need special screening. NCI says to stay up to date with screenings and ask your doctor which cancer screenings you should have and when. (ACS, second cancers) (NCI, follow-up)

Who checks for my first cancer coming back?

Your follow-up care plan covers that. NCI says regular check-ups after treatment look for the cancer you were treated for and any new cancer, and your doctor can suggest which tests you need and how often. (NCI, late effects) (NCI, follow-up)

What is a second cancer?

ACS says a second cancer is a new, different cancer that is unrelated to the first one. It is not the same as a recurrence, when the same cancer comes back. Second cancers are not common. (ACS, second cancers)

Is a screening test after childhood cancer a sign the doctor thinks I have cancer?

No. NCI says a doctor does not necessarily think a childhood cancer survivor has cancer when suggesting a screening test; screening tests are given when there are no symptoms. (NCI PDQ, childhood)

What is a survivorship care plan?

NCI says it is a summary of your treatment along with recommendations for your care after treatment ends. MedlinePlus says it can list the follow-up screenings and tests you will need and the types and dates of visits. (NCI, follow-up) (MedlinePlus)