More than 1.2 million women and men worldwide are diagnosed with breast cancer each year. In 2007, the 20 year survival rate for breast cancer will be greater than the five year survival rate 30 years ago.1 Breast cancer is now recognised as a chronic disease that can recur even after 20-30 years. Follow-up protocols vary widely—both within and between countries—and are not always evidence based. The challenge is to develop follow-up programmes that reflect current knowledge and meet the ongoing needs of this growing number of people.

Guidelines from the National Institute for Health and Clinical Excellence (NICE) in England and Wales state that the aims of breast cancer follow-up are to detect and treat local recurrence, to deal with adverse effects of treatment, and to provide psychological support.2 Routine surveillance for metastatic disease is not recommended because data from randomised studies have shown no improvement in outcomes for patients who undergo intensive programmes to detect and treat asymptomatic metastatic disease. The guidelines suggest that the aims can be met by two to three years of follow-up, and they conclude …