Table 1.

Surveillance and screening for asymptomatic breast cancer survivors

MANEUVER	RECOMMENDATION	LEVEL OF EVIDENCE^*
do ...
Primary care visit with history and physical examination	• Every 3–6 mo for years 1–3 after treatment; every 6–12 mo for years 4 and 5; then annually	III¹⁴
	• History to focus on symptoms of distant (bone, lung, liver, brain) and local recurrence
	• Examination focuses on surgical scar, breasts, chest wall, regional nodes, arms for lymphedema, and common sites of distant spread
	• Annual gynecologic examination for patients taking tamoxifen
Breast self-examination	• Monthly breast self-examination is recommended in this higher risk group	III¹⁴
Mammography	• Annually, starting 1 y after initial mammogram but at least 6 mo after radiation therapy is complete; can perform every 6 mo in select cases; no routine imaging of a reconstructed breast is needed	II¹⁴
Screen for other cancers	• As for average-risk individuals, unless family history suggests otherwise	II¹⁵
do not do ...
Breast magnetic resonance imaging	• Not recommended	I^14,16,17
Other tests Complete blood counts Liver function tests Routine imaging of chest, abdomen, or bone Tumour markers	• Not recommended	I^14,18
Cardiac imaging	• Not recommended after completion of anthracycline (epirubicin, doxorubicin) or trastuzumab therapy unless there are symptoms	III¹⁵

↵* Level I evidence includes at least 1 properly conducted randomized controlled trial, systematic review, or meta-analysis. Level II evidence includes other comparison trials; non-randomized, cohort, case-control, or epidemiologic studies; and preferably more than 1 study. Level III evidence includes expert opinion or consensus statements and influential reports or studies.