Numerous organizations have provided guidelines for clinical follow-up of women after they have undergone breast cancer treatment. The American Society of Clinical Oncology (ASCO) recommends clinic visits every 3 to 6 months for the first 3 years, visits every 6 to 12 months for the next 2 years, and annual visits after 5 years, with no advice on discharging patients . The Canadian Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer are more pragmatic regarding the frequency of visits, and suggests that these should be tailored to individual patient needs, but their recommendations explicitly state that follow-up should be provided indefinitely . The National Institute for Health and Clinical Excellence (NICE) in the UK suggests that clinical follow-up should be limited to only 2 or 3 years .
There is also varying advice regarding mammographic follow-up. Mammography is recognized as important in the Canadian guidelines, with mammograms recommended annually , although the Canadian guidelines do concede that there is little high level evidence to support this practice. Similar recommendations are made by ASCO . In contrast, NICE suggests that the yield of mammography is low and that local networks should decide on their own policy. The British Association of Surgical Oncology has reported that the ideal frequency of mammography has not yet been established and that mammography every 1 to 2 years should be undertaken for up to 10 years after diagnosis . There is clearly disagreement between the groups that have published guidelines, but common to all of the guidelines is an emphasis on providing intensive follow-up during the first 3 to 5 years after diagnosis and treatment, with either reduced frequency of visits or discharge to the general practitioner thereafter. The bases of these guidelines are the perceptions that recurrent disease is most common in the first 3 to 5 years after treatment and that clinical examination remains an important component of follow-up.