ASCO has updated its guideline on follow-up after primary treatment for breast cancer, published in July. An expert panel carried out a systematic review and found one randomised trial, which underpins the recommendation on surveillance mammography. No trials compared follow-up strategies tailored to recurrence risk, so most recommendations were reached by formal modified Delphi consensus.
The core is unchanged in spirit: regular history, physical examination and mammography. Visits may be virtual or in person. The guideline introduces a risk-based approach to how often and how intensively patients are followed, with closer surveillance for those at high risk of recurrence, such as women with locally advanced disease or residual disease after neoadjuvant chemotherapy. It also addresses blood-based biomarkers and supplemental imaging; readers should check the full guideline for those specific recommendations.
For radiologists, mammography remains the backbone of imaging surveillance. Requests for additional imaging in asymptomatic women should be checked against the guideline rather than accepted by default.
The evidence base is thin, and the panel says it will revise the guidance as better tools for individualising surveillance appear.
- Keep mammography as the core imaging test in surveillance after breast cancer treatment.
- Expect closer follow-up requests for locally advanced disease or residual disease after neoadjuvant therapy.
- Check requests for extra imaging in asymptomatic survivors against the full guideline.
- Accept that follow-up visits may be virtual; imaging still needs to be scheduled.
- Report new symptoms promptly, whatever the surveillance interval.
Why it matters
It gives a reason to resist routine extra scanning in well survivors while focusing attention on those most likely to relapse.
Don't overread it
Most recommendations rest on expert consensus rather than trials, because the trials do not exist.
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