From the Guidelines
The recommended follow-up period for breast cancer is at least 5 years, with lifelong monitoring often advised, as stated in the most recent guideline from 2019 1. After completing primary treatment, patients should have clinical examinations every 3-6 months for the first 3 years, every 6-12 months for years 4-5, and annually thereafter. Some key points to consider in the follow-up of breast cancer patients include:
- Annual mammography is recommended for all patients who have undergone breast-conserving surgery, with the first mammogram typically scheduled 6-12 months after radiation therapy completion.
- For patients who had a mastectomy, annual imaging of the remaining breast is recommended.
- Additional imaging such as MRI may be appropriate for high-risk patients, particularly those with genetic mutations or dense breast tissue.
- Laboratory tests and advanced imaging (CT, PET, bone scans) are not routinely recommended for asymptomatic patients but should be performed if recurrence is suspected. This extended follow-up period is crucial because breast cancer can recur even decades after initial treatment, with the risk of recurrence continuing for at least 20 years, especially for hormone receptor-positive cancers, as supported by evidence from 1.
From the Research
Follow-up Years for Breast Cancer
- The frequency and duration of follow-up visits for breast cancer patients can vary depending on individual patient needs and risk factors 2.
- A study published in 1998 recommended regular follow-up surveillance for all patients who have completed primary treatment for breast cancer, with visits scheduled at 4-6 weeks, 4-6 months, and approximately 1-year intervals indefinitely thereafter 2.
- Another study published in 2018 proposed a risk-based follow-up scheme stratified by age, with more intensive follow-up around the peak in recurrence risk in the second year after diagnosis 3.
- The study suggested that for women under 50, a slightly more intensive follow-up with one extra visit was proposed compared to the current guideline recommendation, while women aged 50-59,60-69, and over 70 required fewer visits 3.
- A 2020 study evaluated the age-based recommendations for long-term follow-up in breast cancer and found that the current consensus-based recommendations use suboptimal age cutoffs, leading to situations where women with higher risks receive less follow-up than those with lower risks 4.
- The study proposed alternative age cutoffs (<50-69, and >69) that could provide more risk-based schedules, but noted that more factors, including systemic treatments, should be taken into account for truly individualizing follow-up based on risk for recurrence 4.
- A 2020 study on follow-up care for breast cancer survivors found that there is a substantial and increasing rate of inadequate follow-up among breast cancer survivors, which has the potential to impair outcomes 5.
Recommended Follow-up Duration
- The recommended follow-up duration for breast cancer patients is at least 5 years, with annual follow-up visits 2, 4.
- After 5 years, the follow-up schedule can be adjusted based on individual patient needs and risk factors, with some studies suggesting biennial or less frequent visits for women over 60 or 70 years old 4.