Medical Oncologist
Medicines
Tests and monitoring while you are on exemestane
Exemestane needs only light monitoring, but the years on treatment are a good time to protect your bones, heart and breast health. This page explains which tests are commonly done before and during exemestane, how often, why routine scans are not used in early breast cancer, and which symptoms to report between appointments.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
On this page
- Which tests will you have while taking exemestane?
- Four tests you are likely to have
- When tests are usually done
- The vocabulary, in plain language
- What tests can and cannot show
- What happens after your bone density result
- Symptoms to report without waiting
- Myths about monitoring on exemestane
- Common questions about tests on exemestane
The short answer
Which tests will you have while taking exemestane?
Exemestane itself needs only light monitoring, but the years you spend on it are a good time to keep a close eye on your bones, your heart health and the breast area. Before you start, your team makes sure exemestane is the right tablet for you. If there is any doubt about whether you have been through menopause, for example if your periods stopped during chemotherapy or you had a hysterectomy but kept your ovaries, a blood test for oestradiol and other hormones may be done, sometimes more than once. Most women also have a baseline bone density scan, because aromatase inhibitors can thin the bones, and many have their vitamin D and cholesterol checked. During treatment, you will have regular clinic reviews, which are more frequent in the first few years and then spaced out. If you still have breast tissue, a mammogram is usually done every year. Bone density scans are repeated at intervals that depend on your first result and your other risks. Cholesterol may be rechecked, particularly if you have heart risk factors. For early breast cancer, routine body scans and tumour marker blood tests are not usually needed when you feel well, because they have not been shown to help. Instead, your team relies on how you are feeling and any new symptoms you report. For advanced breast cancer, scans are done more regularly to check the treatment is working.
Bones are the main focus
A bone density scan at the start and at intervals helps catch thinning early.
Hormone tests when menopause is uncertain
Blood tests confirm oestrogen is low enough for exemestane to work properly.
Symptoms matter more than routine scans
In early breast cancer, reporting new symptoms is more useful than regular scans.
This page gives general information only. Your team will set your own schedule of tests.The key checks
Four tests you are likely to have
Each one looks after a different part of your health.
Bone density scan
A quick, low-dose X-ray scan of the hip and spine, often called a DEXA scan. It shows whether bones are normal, thinner than average or at higher risk of breaking.
Mammogram
A yearly breast X-ray of any remaining breast tissue, usually continuing well beyond the end of hormone therapy.
Cholesterol blood test
Lower oestrogen can nudge cholesterol upward. A check helps decide whether diet, exercise or medicine is needed.
This matters more if you have diabetes, high blood pressure or heart disease.Hormone levels, for some women
Oestradiol and related hormone tests are used when menopause is uncertain or ovaries are being suppressed.
Who may need them
- Women whose periods stopped with chemotherapy
- Women on ovarian suppression injections
- Women with a hysterectomy who kept their ovaries
A typical pattern
When tests are usually done
Test
Usual timing
Clinic review
Every few months at first, then less often as the years pass
Bone density scan
Before or soon after starting, then repeated at intervals your team sets
Mammogram
Usually once a year if breast tissue remains
Cholesterol and vitamin D
At the start and then as advised, especially with heart or bone risks
Scans in advanced cancer
Every few months, or sooner if symptoms change
Words you may hear
The vocabulary, in plain language
- DEXA scan
- A low-dose X-ray that measures how dense and strong your bones are.
- T-score
- A bone density result compared with a healthy young adult; lower scores mean thinner bones.
- Osteopenia
- Bones that are thinner than average but not yet at the level called osteoporosis.
- Oestradiol
- The main form of oestrogen, measured in the blood to confirm levels are low.
- Lipid profile
- A blood test measuring cholesterol and other fats linked to heart health.
- Tumour marker
- A blood protein sometimes raised by cancer, mainly used in advanced disease.
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Being straight with you
What tests can and cannot show
It is natural to want more tests for reassurance, but more is not always better.
Routine scans in early cancer
Research has not shown that regular body scans or tumour marker tests in women without symptoms help people live longer. They can also cause worry from unclear findings and extra radiation.
Normal results are not a promise
A clear mammogram or normal blood test is reassuring, but no test can rule out every future problem.
What this page cannot tell you
It cannot tell you exactly which tests you need or how often. Schedules vary with your cancer, other health conditions and local practice.
Understanding your bone scan
What happens after your bone density result
Your bone scan result, along with your age, past fractures and other risks, guides what happens next.
Normal bone density
Weight-bearing exercise, enough calcium and vitamin D, and a repeat scan in a few years are usually all that is needed.
Thinner than average
Your team may advise supplements, more exercise and a repeat scan sooner. Some women are offered bone-strengthening medicine.
Osteoporosis or high fracture risk
Medicines such as zoledronic acid, denosumab or bisphosphonate tablets are commonly recommended. A dental check before starting some of these is advised, because they rarely affect the jawbone.
Between appointments
Symptoms to report without waiting
Because routine scans are not used in early breast cancer, what you notice yourself is an important part of monitoring.
Possible signs of recurrence
A new lump in the breast, chest wall, armpit or neck, bone pain that persists and is worse at night, a cough or breathlessness that does not settle, or unexplained weight loss should be checked.
Possible side effects
Severe joint pain, very low mood, a broken bone after a minor fall, or yellowing of the skin or eyes should also be reported.
Keep a simple record
Noting when a symptom started and whether it is getting worse helps your team decide quickly whether tests are needed.
Commonly believed
Myths about monitoring on exemestane
A yearly PET-CT scan would catch any return early.
Routine scans without symptoms are not recommended in early breast cancer, as they have not been shown to help.
Blood tests show whether exemestane is working.
No blood test shows this in early cancer. Hormone tests only confirm oestrogen is low.
If my bones thin, I must stop exemestane.
Bone thinning can usually be treated so you can keep taking your hormone therapy.
Once hormone therapy ends, I no longer need mammograms.
Breast imaging usually continues long after tablets stop.
Questions we are asked
Common questions about tests on exemestane
Do I need to fast before my blood tests?
Most blood tests during exemestane do not need fasting. Some cholesterol or blood sugar tests are done after an overnight fast, so check the instructions when the test is booked. If fasting is needed, take your exemestane after you have eaten once the sample has been taken.
Is a DEXA scan painful or risky?
No. You lie on a padded table while a scanner arm passes over your hip and spine for a few minutes. The radiation dose is very low, much less than a standard chest X-ray. You can usually stay in your clothes, but avoid metal zips, buttons and belts.
Why do I need hormone tests if my periods have stopped?
Periods can stop after chemotherapy while the ovaries are still able to recover. Exemestane on its own does not work if the ovaries are active, and it can even stimulate them. Blood tests help confirm that oestrogen is truly low, and they may be repeated during the first year.
Will tumour markers such as CA 15-3 be checked?
In early breast cancer, routine tumour marker tests are generally not recommended during follow-up, because raised levels are unreliable and acting on them early has not been shown to help. In advanced breast cancer, markers are sometimes used alongside scans to track how treatment is working.
Does exemestane affect liver tests?
Mild changes in liver blood tests are occasionally seen with exemestane. They rarely cause problems, and routine liver tests are not always needed. Tell your team if you notice yellowing of the skin or eyes, dark urine or persistent tummy pain, as these should be checked.
How often will I see my oncologist?
Reviews are usually every few months in the first years after treatment, then less often. Some centres share follow-up with a specialist nurse or local doctor. You can ask for an earlier appointment at any time if you have a new symptom or concern.
What extra checks are needed with everolimus?
When exemestane is combined with everolimus for advanced cancer, monitoring is closer. Blood sugar, cholesterol, blood counts and kidney tests are checked regularly, and your team watches for mouth sores, breathing symptoms and infections. You will be given a clear schedule.
Should I keep copies of my test results?
Yes, it is helpful. Keeping copies of bone scans, blood tests and mammogram reports lets any doctor see how things have changed over time. This is especially useful if you move, change hospitals or see different specialists during your years of treatment.
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Speak to a breast cancer specialist
Call the helpline or leave your details, and someone will help you arrange a consultation at the CION centre nearest you. One helpline serves every CION centre.
Call 1800 202 8726
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Sources
- Macmillan Cancer Support — Exemestane
- American Cancer Society — Follow-up Care After Breast Cancer Treatment
- Cancer Research UK — Exemestane (Aromasin)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.