Breast Cancer

, Volume 26, Issue 5, pp 681–686 | Cite as

Discrepancies of current recommendations in breast cancer follow-up: a systematic review

  • Anastasios KyriazoglouEmail author
  • Flora Zagouri
  • Despina Fotiou
  • Constantinos Dimitrakakis
  • Spyros Marinopoulos
  • Roubini Zakopoulou
  • Maria Kaparelou
  • Anna Zygogianni
  • Meletios Athanasios Dimopoulos
Rapid Communication



Management and optimal follow-up of early breast cancer survivors remain up to this day a challenge due to the lack of well-established guidelines. Multiple medical societies, organizations and working groups have provided recommendations for follow-up but there is no uniform, globally approved algorithm to guide clinical practice.


A systematic review was performed to identify and evaluate discrepancies between available guidelines for the follow-up of breast cancer survivors.


Differences in the follow-up schedule, laboratory and imaging investigations were noted. In the clinical practice setting, the situation is complicated further by clinicians who often request unnecessary tests not currently incorporated in any of the existing guidelines.


Follow-up of patients with early breast cancer needs to become standardized and prospective clinical trials focusing on optimal follow-up are more than mandatory.


Follow-up Breast cancer Guidelines Clinical practice Discrepancies 



We appreciate Dr. Andreas Giannopoulos contribution on English language editing.

Compliance with ethical standards

Ethical standards

The authors declare that this systematic review was conducted according to the laws of Greece.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Mitus JW, Blecharz P, Walasek T, Reinfuss M, Jakubowicz J, Kulpa J. Treatment of patients with distant metastases from phyllodes tumor of the breast. World J Surg. 2016;40:323–8.CrossRefGoogle Scholar
  2. 2.
    Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, et al. NCCN guidelines insights: breast cancer, version 1.2017. J Natl Compr Cancer Netw. 2017;15:433–51.CrossRefGoogle Scholar
  3. 3.
    Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E, et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v8–30.CrossRefGoogle Scholar
  4. 4.
    Grunfeld E, Dhesy-Thind S, Levine M, Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: follow-up after treatment for breast cancer (summary of the 2005 update). CMAJ. 2005;172:1319–20.CrossRefGoogle Scholar
  5. 5.
    Thomssen C, Scharl A, Harbeck N. AGO recommendations for diagnosis and treatment of patients with primary and metastatic breast cancer. Update 2011. Breast Care (Basel). 2011;6:299–313.CrossRefGoogle Scholar
  6. 6.
    Dewis R, Gribbin J. Breast cancer: diagnosis and treatment: an assessment of need. Cardiff: National Collaborating Centre for Cancer; 2009.Google Scholar
  7. 7.
    Barnadas A, Algara M, Cordoba O, Casas A, Gonzalez M, Marzo M, et al. Recommendations for the follow-up care of female breast cancer survivors: a guideline of the Spanish Society of Medical Oncology (SEOM), Spanish Society of General Medicine (SEMERGEN), Spanish Society for Family and Community Medicine (SEMFYC), Spanish Society for General and Family Physicians (SEMG), Spanish Society of Obstetrics and Gynecology (SEGO), Spanish Society of Radiation Oncology (SEOR), Spanish Society of Senology and Breast Pathology (SESPM), and Spanish Society of Cardiology (SEC). Clin Transl Oncol. 2018;20:687–94.CrossRefGoogle Scholar
  8. 8.
    Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. J Clin Oncol. 2016;34:611–35.CrossRefGoogle Scholar
  9. 9.
    Australian Government NHaMRC. Clinical practice guideline for the management of early breast cancer, 2nd ed. Canberra: Australian Government NHaMRC; 2001.Google Scholar
  10. 10.
    Larson KE, Grobmyer SR, Valente SA. Evaluation of recurrence patterns and survival in modern series of young women with breast cancer. Breast J. 2018;24(5):749–54.CrossRefGoogle Scholar
  11. 11.
    Louie RJ, Tonneson JE, Gowarty M, Goodney PP, Barth RJ Jr, Rosenkranz KM. Complete blood counts, liver function tests, and chest X-rays as routine screening in early-stage breast cancer: value added or just cost? Breast Cancer Res Treat. 2015;154:99–103.CrossRefGoogle Scholar
  12. 12.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9, W64.CrossRefGoogle Scholar
  13. 13.
    De Placido S, De Angelis C, Giuliano M, Pizzi C, Ruocco R, Perrone V, et al. Imaging tests in staging and surveillance of non-metastatic breast cancer: changes in routine clinical practice and cost implications. Br J Cancer. 2017;116:821–7.CrossRefGoogle Scholar
  14. 14.
    Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:961–5.CrossRefGoogle Scholar
  15. 15.
    Grossmann M, Ramchand S, Milat F, Vincent A, Lim E, Kotowicz MA, et al. Assessment and management of bone health in women with oestrogen receptor-positive breast cancer receiving endocrine therapy: position statement of the Endocrine Society of Australia, the Australian and New Zealand Bone & Mineral Society, the Australasian Menopause Society and the Clinical Oncology Society of Australia. Clin Endocrinol (Oxf). 2018;89(3):280–96.CrossRefGoogle Scholar
  16. 16.
    Duffy MJ, McDermott EW, Crown J. Blood-based biomarkers in breast cancer: from proteins to circulating tumor cells to circulating tumor DNA. Tumour Biol. 2018;40:1010428318776169.CrossRefGoogle Scholar
  17. 17.
    Azim HA Jr, Davidson NE, Ruddy KJ. Challenges in treating premenopausal women with endocrine-sensitive breast cancer. Am Soc Clin Oncol Educ Book. 2016;35:23–32.CrossRefGoogle Scholar
  18. 18.
    Schmidt ME, Wiskemann J, Steindorf K. Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res. 2018;27(8):2077–86.CrossRefGoogle Scholar
  19. 19.
    Ghizzani A, Bruni S, Luisi S. The sex life of women surviving breast cancer. Gynecol Endocrinol. 2018;34(10):821–5.CrossRefGoogle Scholar
  20. 20.
    Grunfeld E, Julian JA, Pond G, Maunsell E, Coyle D, Folkes A, et al. Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol. 2011;29:4755–62.CrossRefGoogle Scholar
  21. 21.
    Berger O, Gronberg BH, Loge JH, Kaasa S, Sand K. Cancer patients’ knowledge about their disease and treatment before, during and after treatment: a prospective, longitudinal study. BMC Cancer. 2018;18:381.CrossRefGoogle Scholar
  22. 22.
    Nippert I, Julian-Reynier C, Harris H, Evans G, van Asperen CJ, Tibben A, et al. Cancer risk communication, predictive testing and management in France, Germany, the Netherlands and the UK: general practitioners’ and breast surgeons’ current practice and preferred practice responsibilities. J Community Genet. 2014;5:69–79.CrossRefGoogle Scholar
  23. 23.
    Mosconi P, Torri V, Cifani S, Ruggiata R, Meyerowitz BE, Apolone G, et al. The multi-centre assessment of quality of life: the Interdisciplinary Group for Cancer Care Evaluation (GIVIO) experience in Italy. Stat Med. 1998;17:577–85.CrossRefGoogle Scholar
  24. 24.
    Williams ST, Sykes MC, Boon Lim P, Salciccioli JD. The 2015 advanced life support guidelines: a summary and evidence for the updates. Emerg Med J. 2016;33:357–60.CrossRefGoogle Scholar
  25. 25.
    Hojo T, Masuda N, Mizutani T, Shibata T, Kinoshita T, Tamura K, et al. Intensive vs. standard post-operative surveillance in high-risk breast cancer patients (INSPIRE): Japan Clinical Oncology Group Study JCOG1204. Jpn J Clin Oncol. 2015;45:983–6.CrossRefGoogle Scholar
  26. 26.
    Moschetti I, Cinquini M, Lambertini M, Levaggi A, Liberati A. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev. 2016. Scholar

Copyright information

© The Japanese Breast Cancer Society 2019

Authors and Affiliations

  • Anastasios Kyriazoglou
    • 1
    Email author
  • Flora Zagouri
    • 1
  • Despina Fotiou
    • 1
  • Constantinos Dimitrakakis
    • 2
  • Spyros Marinopoulos
    • 2
  • Roubini Zakopoulou
    • 1
  • Maria Kaparelou
    • 1
  • Anna Zygogianni
    • 3
  • Meletios Athanasios Dimopoulos
    • 1
  1. 1.Department of Clinical Therapeutics, General Hospital AlexandraNational and Kapodistrian University of Athens, School of MedicineAthensGreece
  2. 2.Department of Obstetrics and GynecologyGeneral Hospital AlexandraAthensGreece
  3. 3.Department of Radiology, General Hospital AretaieionNational and Kapodistrian University of Athens, School of MedicineAthensGreece

Personalised recommendations