Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Breast Cancer Follow-Up and Surveillance After Primary Treatment

American Society of Clinical Oncology

Publication Date: Jul 16, 2026

Page Last Updated: Jul 17, 2026

Recommendation Rating Definitions

Quality of Evidence
Term		Definitions
H	- High	We are very confident that the true effect lies close to that of the estimate of the effect
M	- Moderate	We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
L	- Low	Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
VL	- Very Low	We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Strength of Recommendation
Term		Definitions
S	- Strong	In recommendations for an intervention, the desirable effects of an intervention outweigh its undesirable effects. In recommendations against an intervention, the undesirable effects of an intervention outweigh its desirable effects. All or almost all informed people would make the recommended choice for or against an intervention.
W	- Weak	In recommendations for an intervention, the desirable effects probably outweigh the undesirable effects, but appreciable uncertainty exists. In recommendations against an intervention, the undesirable effects probably outweigh the desirable effects, but appreciable uncertainty exists. Most informed people would choose the recommended course of action, but a substantial number would not.

GRADE Handbook, Schünemann, et al. 2013.

Document Overview

Document Title: Breast Cancer Follow-Up and Surveillance After Primary Treatment

Authoring Society: American Society of Clinical Oncology

Document Publication Date: Jul 16, 2026

Page Last Reviewed/Updated: Jul 17, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/10.1200/JCO-26-01700

Source Citation: Nahleh Z, Alfano CM, Somerfield MR, Lee JM, Hieken TJ, Magnuson A, Rao RD, Chew HK, Chia SKL, Harvey BE, Landsberger E, Lim B, Mwanzi SA, Parsons HA, Patt D, Sukumar JS, Sung H, Werutsky G, Lustberg M. Breast Cancer Follow-Up and Surveillance After Primary Treatment: ASCO Guideline Update. J Clin Oncol. 2026 Jul 16:101200JCO2601700. doi: 10.1200/JCO-26-01700. Epub ahead of print. PMID: 42462191.

Document Scope, Criteria, and Use Cases

Document Objectives: The purpose of this guideline is to offer clinicians recommendations concerning breast cancer follow-up and surveillance after primary treatment. The guideline offers recommendations on the role of a risk-based approach to the frequency and intensity of follow-up among patients with breast cancer in the adjuvant setting. Regular history, physical examination, and mammography are recommended for breast cancer follow-up. Either virtual or in-person visits can be offered. Certain patients at high risk of cancer recurrence warrant closer surveillance, such as those patients with locally advanced disease or residual disease following neoadjuvant chemotherapy. Recommendations on the use of blood-based biomarkers and supplemental imaging are provided. Guideline recommendations will be updated once additional evidence-based tools become available to better individualize surveillance.

Scope: Assessment and Screening, Management, Treatment

Keywords: breast cancer

Target Patient Population: Patients with breast cancer who have completed primary therapy with curative intent and who are without clinical evidence of disease

Target Provider Population: Oncology specialists, other clinicians, and any other relevant member of a comprehensive multidisciplinary cancer care team, as well as caregivers and patients

Inclusion Criteria: Female, Adult, Older Adult

Health Care Settings: Ambulatory, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

What is the role of a risk-based approach to the frequency and intensity (type of and number of tests) of follow-up among patients with varying risks of breast cancer recurrence in the adjuvant setting after curative-intent primary therapy?

Breast Cancer Follow-Up and Surveillance After Primary Treatment

Summary of Recommendations

General Notes

Low-Intensity Surveillance Group

1.1.1.

1.1.2.

Intermediate-Intensity Surveillance Group

1.2.1.

1.2.2.

High-Intensity Surveillance Group

1.3.1.

1.3.2.

Use of Blood-Based Biomarkers in Breast Cancer

2.1.

2.2.

Supplemental Surveillance Imaging

3.1.

3.2.

3.3.

3.4.

Recommendation Rating Definitions

Document Overview

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology