Intended for healthcare professionals


Follow-up after breast cancer

BMJ 2008; 336 doi: (Published 17 January 2008) Cite this as: BMJ 2008;336:107
  1. J M Dixon, consultant surgeon and senior lecturer in surgery; clinical director, Edinburgh breakthrough research unit1,
  2. David Montgomery, clinical research fellow2
  1. 1Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU
  2. 2Department of Surgery, Glasgow Royal Infirmary, Glasgow G4 0SF
  1. jmd{at}

    Should be evidence based, flexible, and tailored to patients’ lifelong needs

    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 …

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