What are the differences between the NCCN and ASCO guidelines for the long-term monitoring of breast cancer survivors?

Updated: Feb 04, 2021
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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There is no consensus among oncologists as to appropriate and optimal follow-up for long-term breast cancer survivors. The majority of relapses, both local and distant, occur within the first 3 years, especially in higher-risk and ER-negative patients. The 2007 ASCO guidelines do not support the use of tumor biomarkers, including CEA, CA15.3, and CA27.29, for monitoring patients for recurrence after primary breast cancer therapy. ASCO and NCCN have both provided recommendations for surveillance in the adjuvant setting (see Table 5 below).

Table 5. Follow-up Recommendations for Breast Cancer Survivors (Open Table in a new window)




History and physical examination

Year 1, every 3-4 mo

Year 2, every 4 mo

Year 3-5, every 6 mo

Year 6+, annually

Year 1-3, every 3-6 mo

Year 4-5, every 6-12 mo

Year 6+, annually

Breast self-examination

No recommendation

Counseled to perform monthly breast self-examination


6 mo after post-BCS radiation therapy

Annually thereafter

6 mo after definitive radiation therapy

Every 6-12 mo for surveillance of abnormalities

Annually if stability of abnormalities is achieved

Pelvic examination

Annually, for women on tamoxifen

Annual exam if uterus present

Regular gynecologic follow-up

Patients on tamoxifen should be advised to report any vaginal bleeding

Routine blood tests

Not recommended

Not recommended

Imaging studies

Not recommended

Not recommended

Tumor marker testing

Not recommended

Not recommended

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