Appropriate follow-up after breast cancer?

[Elle53]

My medical history:  Invasive ductal carcinoma, dx Aug. 1, 2003.  Had lumpectomy Aug. 1, re-excision on Aug. 25.  Began 4 rounds of A/C on Sept. 17.  Began 33 radiation treatments on Dec. 29 (7 of these were boosts).  Tumor was 1.1 centimeter, histologic grade I, nuclear grade I, no tumor necrosis seen, no neurovascular invasion seen, negative lymph nodes, Her2neu negative, ER and PR positive.  Tumor calcification is minimal.  My question:  What would be an appropriate follow-up for the next few years?  I just saw my medical oncologist last week (I finish the boosts this week) and he said I should come back in 6 months (August).  After that he said I should return once a year.  Is this frequent enough?  From what I've read, it doesn't sound like it is.  Even though the tumor was the slow-growing type, it is still invasive cancer and I am very scared.  I'd like someone "watching" me for a couple of years.  

I also started Tamoxifen a month ago and will be taking it for 5 years.

Also, my treatment was not at a big medical center, rather, a small-town hospital if that makes any difference.  

Thanks so much for your opinion.

[CCF-RN,MSN-rf]

Dear Elle53:  Different physicians differ slightly in their follow up practices.  When there have been multiple subspecialties involved, most will like to see the patient somewhat soon after all therapy has been completed to be sure all is going okay.  Being a large place, we often have the patient visit everyone, surgeon, radiation oncologist, medical oncologist on the same day (about 3 months after treatment in most cases).  After that, one of the doctors, usually the medical oncologist, becomes the primary person to do followup.  The radiation oncologist and surgeon do not provide regular follow up.  This is at a large center where all are on the same campus.  Practices may differ in the community.  Different practies are not necessarily incorrect.  Follow up is usually every 6 months for a year or two, then every year, unless individual circumstances dictate otherwise.  To some extent, frequency of follow-up has to do with the comfort of all individuals - including you.  Remember, you will still need a mammogram every year.

[surgeon]

My personal approach, as a surgeon, has been to see the woman initially 3 months after completion of radiation to establish a baseline exam for how things are after treatment; then every 6 months for two years, and then yearly. One problem is there is a surgeon, a radiation oncologist, and a medical oncologist involved; it hardly seems necessary to see all of them that often. I often would suggest alternating appointments so that the woman would see someone every 6 months for that first 2 years. Which she would see, in what order, would depend on the various preferences of all those involved. The fact is that some studies have shown that less frequent followup is ok, too. So it boils down to a mutual agreement of what makes the most comfort for the people involved. You can expect an answer also from the Cleveland Clinic people which would presumably reflect their approach.