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After treatment for early breast cancer, the main test is a yearly mammogram, usually for 5 years and then through the national screening programme. Routine scans and blood tests are not recommended when you are well, because the evidence does not show they help. You should get a written plan saying who to contact and which symptoms to report.
NICE NG101 offers annual mammography for 5 years to everyone who has had or is being treated for breast cancer, including DCIS, and for women continued annually until they enter the national screening programme; no mammography of the soft tissues on the side of a mastectomy; and no routine ultrasound or MRI for surveillance. ASCO (2013) recommends history and physical examination every 3 to 6 months for the first 3 years, every 6 to 12 months in years 4 and 5, and annually after that, with the first post-treatment mammogram 1 year after the initial one and at least 6 months after radiotherapy. Both advise against routine blood tests, tumour markers and body imaging in people without symptoms; the ACS/ASCO survivorship guideline (2016) agrees.
Every person should have an agreed written care plan held by them and their GP, with named professionals, dates for review of adjuvant therapy, the surveillance mammography, symptoms to report and how to reach specialist care quickly (NICE). Primary care follow-up includes healthy lifestyle advice, monitoring for long-term effects of treatment, and support to keep taking endocrine therapy (ACS/ASCO). Bone density checks on aromatase inhibitors and lymphoedema care are covered by their own protocols.
Why: Most returns are noticed by the person between appointments, so knowing what to look for and whom to call matters more than the visits themselves.
“Ensure all people who have had treatment for breast cancer have an agreed, written care plan, recorded in their notes by a named healthcare professional (or professionals) from the multidisciplinary team. Give a copy to the person and to their GP.”
Why: Mammography finds a return in the treated breast or a new cancer in the other breast early.
“Offer annual mammography for 5 years to all people who have had or are being treated for breast cancer, including DCIS.”
Why: Changes from radiotherapy settle over months, and an early image is harder to read.
“For women who have undergone breast-conserving surgery, a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy.”
Why: There is no breast tissue left to image there; changes are found by examination and symptoms.
“Do not perform mammography of the ipsilateral soft tissues after mastectomy.”
Why: NICE found no reason to use them routinely for people at ordinary risk; they find more harmless changes that then need checking.
“Do not routinely use ultrasound or MRI for post-treatment surveillance in people who have had treatment for invasive breast cancer or DCIS.”
Why: Regular review is a chance to check symptoms, side effects and whether endocrine therapy is being taken.
“Physical examinations should be performed every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and annually thereafter.”
Why: The evidence does not support these tests in people without symptoms, and a false alarm leads to more tests and worry.
“is not recommended for routine follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination.”
Why: These are linked with a lower risk of the cancer coming back.
“Advise people who have had or are being treated for breast cancer that a healthy lifestyle is associated with a lower risk of recurrence, and that this should include:”
Why: Long-term side effects affect daily life, and stopping endocrine therapy early loses part of its benefit.
“Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy.”
American Cancer Society and ASCO, Journal of Clinical Oncology 2016
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
NICE NG101 (last updated 2025) and ASCO (2013, reaffirmed by ACS/ASCO in 2016) agree on the core: yearly mammography, clinical review, a written plan, and no routine blood tests, tumour markers or body imaging in people without symptoms. They differ in detail: NICE sets mammography yearly for 5 years and then hands over to the screening programme, and advises against routine ultrasound or MRI; ASCO sets a schedule of clinical examinations (every 3 to 6 months for 3 years, 6 to 12 months to year 5, then yearly) that NICE does not specify. The ESMO 2024 early breast cancer guideline could not be read.
NICE 2018 · ASCO, Journal of Clinical Oncology 2013 · American Cancer Society and ASCO, Journal of Clinical Oncology 2016 · ESMO, Annals of Oncology 2024
Where it differs: Sets a frequency for history and examination for life (every 3 to 6 months for 3 years, every 6 to 12 months for years 4 and 5, then yearly), where NICE sets no visit schedule and relies on the written plan and open access to the specialist team.
Evidence: ASCO's 2013 update found no new evidence that warranted changing its 2006 recommendations; ACS/ASCO (2016) say most evidence is not sufficient for a strong evidence-based recommendation. Read as abstracts.
ASCO, Journal of Clinical Oncology 2013 · American Cancer Society and ASCO, Journal of Clinical Oncology 2016
Where it differs: After 5 years of yearly mammography, women continue yearly until they enter the NHS Breast Screening Programme in England or Breast Test Wales, after which screening follows the programme's own interval.
Evidence: NICE recommendation [2009, amended 2023]; NICE does not grade recommendations.
Not every survivor needs to see an oncologist every six months for years. Sort people by recurrence risk, send low-risk survivors back to their family doctor with a clear plan, and guarantee rapid return if something changes.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Annual mammography for 5 years after breast cancer, including DCIS | not graded (NICE); dated [2009, amended 2023] | NICE 2018 |
| No routine ultrasound or MRI surveillance | not graded (NICE); dated [2009, amended 2023] | NICE 2018 |
| Most survivorship recommendations “Most of the evidence is not sufficient to warrant a strong evidence-based recommendation.” | evidence not sufficient for a strong evidence-based recommendation (ACS/ASCO's own statement) | American Cancer Society and ASCO, Journal of Clinical Oncology 2016 |
Shares Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry, National Institute for Health and Care Excellence, American Society of Clinical Oncology (ASCO), Survivorship care and late-effects surveillance and the tags protocol, follow-up, survivorship.
Shares National Institute for Health and Care Excellence, American Society of Clinical Oncology (ASCO), Breast cancer (all types) and the tags protocol, survivorship.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, survivorship.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, survivorship.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, survivorship.
Shares National Institute for Health and Care Excellence, American Society of Clinical Oncology (ASCO) and the tags protocol, survivorship.
Shares Mammography & tomosynthesis and the tags protocol, survivorship.
Shares Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry, Survivorship care and late-effects surveillance and the tags follow-up, survivorship.