Follow-up of breast cancer: why is it necessary to start a Consensus in 2024?


  • Stefania Gori UOC Oncologia Medica, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona - Italy and Associazione Italiana dei Gruppi Oncologici Multidisciplinari (AIGOM), Genova - Italy
  • Alberto Zambelli Oncologia Medica all’Humanitas University; Capo sezione Senologia oncologica, Centro Oncologico Humanitas IRCCS di Rozzano (MI) - Italy
  • Catia Angiolini Centro Senologia AOU Careggi - Breast Unit, Firenze - Italy
  • Antonella Ferro SS DH Oncologia, coordinatore Breast Unit, Ospedale Santa Chiara, Trento - Italy
  • Fiorenza De Rose UO Radioterapia Oncologica, Ospedale Santa Chiara, Trento - Italy
  • Alessandra Fabi UOSD Medicina di Precisione in Senologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma - Italy
  • Giuseppe Azzarello UOC Oncologia-Ematologia Oncologica del Distretto Mirano-Dolo, Ulss 3 del Veneto - Italy
  • Giuseppe Bogina UOC Anatomia Patologica e Biologia Molecolare, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona - Italy
  • Maurizio Cancian Società Italiana di Medicina Generale e delle Cure Primarie (SIMG), Medico di Medicina Generale, Conegliano (TV) - Italy
  • Matteo Valerio UOC Oncologia Medica, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona - Italy
  • Michela Cinquini Istituto di Ricerche di Farmacologiche Mario Negri IRCCS, Milano - Italy
  • Fabrizio Nicolis Associazione Italiana dei Gruppi Oncologici Multidisciplinari (AIGOM), Genova - Italy and Direzione Sanitaria, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona - Italy
  • Giovanni Pappagallo Coordinatore Scuola Metodologia Ricerca Clinica, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona - Italy



Consensus, Early breast cancer, Follow-up, Mini-Delphi methodology


In Italy, breast cancer is the most frequently diagnosed cancer in women, with 55,900 new cases in 2023 (over 90% in the early stages). Due to the screening, early diagnosis and adjuvant treatment, these patients have a 5-years survival rate of 87% after the diagnosis.

There are 834,154 women in Italy with a previous diagnosis of breast cancer: most of these women require a follow-up.

The AIOM, ESMO and ASCO Guidelines recommend for early breast cancer (EBC) a clinical follow-up with only physical examination (and eliciting of symptoms) and an annual X-ray mammography, on the basis of the results of two randomized trials published in 1994 that showed no benefit in overall survival with intensive follow-up.

However, an Italian survey reported the application by 80% of oncologists of an intensive follow-up based on the individual patient’s risk of recurrence. In fact, the oncologists believe that an early diagnosis of locoregional or distant recurrence may allow an early start of very effective therapies.

In this lack of up-to-date scientific data, many questions about follow-up remain unanswered and the few ongoing studies will provide results in several years.

Non-compliance with guideline recommendations leads to increased costs for the healthcare system. Furthermore, management varies widely from centre to centre with regard to guideline recommendations, resulting in inequalities between patients. For these reasons, the follow-up of breast cancer should be reconsidered.

In the absence of recent scientific evidence, a multidisciplinary group of breast cancer experts has initiated a Consensus on the follow-up of EBC according to the mini-Delphi methodology. The project will be completed by the end of 2024.


Download data is not yet available.


I numeri del canaro in Italia 2023. (Accessed January 10, 2024)

I numeri del cancro in Italia 2020. (Accessed June 22, 2023)

Pan H, Gray R, Braybrooke J, et al; EBCTCG. 20-year risks of breast cancer recurrence after stopping endocrine therapy at 5 years. N Engl J Med. 2017;377(19):1836-1846. PMID:29117498 DOI:

Saphner T, Tormey DC, Gray R. Annual hazard rates of recurrence for breast cancer after primary therapy. J Clin Oncol. 1996;14(10):2738-2746. PMID:8874335 DOI:

Linee guida AIOM Carcinoma Mammario in Stadio Precoce. Edizione 2023. (Accessed January 10, 2024)

Loibl S, André F, Bachelot T. et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology (2023). (Accessed Juanuary 10, 2024) DOI:

Khatcheressian JL, Hurley P, Bantug E, et al; American Society of Clinical Oncology. Breast cancer follow-up and management after primary treatment: american Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961-965. PMID:23129741 DOI:

Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology breast Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol. 2016;34(6):611-635. PMID:26644543 DOI:

de Bock GH, Bonnema J, van der Hage J, Kievit J, van de Velde CJ. Effectiveness of routine visits and routine tests in detecting isolated locoregional recurrences after treatment for early-stage invasive breast cancer: a meta-analysis and systematic review. J Clin Oncol. 2004;22(19):4010-4018. PMID:15459225 DOI:

Montgomery DA, Krupa K, Cooke TG. Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature. Br J Cancer. 2007;97(12):1632-1641. PMID:18000508 DOI:

Lu W, de Bock GH, Schaapveld M, Baas PC, Wiggers T, Jansen L. The value of routine physical examination in the follow up of women with a history of early breast cancer. Eur J Cancer. 2011;47(5):676-682. PMID:21130643 DOI:

Montgomery DA, Krupa K, Cooke TG. Alternative methods of follow up in breast cancer: a systematic review of the literature. Br J Cancer. 2007;96(11):1625-1632. PMID:17486134 DOI:

Loomer L, Brockschmidt JK, Muss HB, Saylor G. Postoperative follow-up of patients with early breast cancer. Patterns of care among clinical oncologists and a review of the literature. Cancer. 1991;67(1):55-60.<55::AID-CNCR2820670111>3.0.CO;2-N PMID:1985723 DOI:<55::AID-CNCR2820670111>3.0.CO;2-N

Pace BW, Tinker MA. Follow-up of patients with breast cancer. Clin Obstet Gynecol. 1994;37(4):998-1002. PMID:7842569 DOI:

Temple LK, Wang EE, McLeod RS. Preventive health care, 1999 update: 3. Follow-up after breast cancer. Canadian Task Force on Preventive Health Care. CMAJ. 1999;161(8):1001-1008. PMID:10551200

Lash TL, Fox MP, Buist DS, et al. Mammography surveillance and mortality in older breast cancer survivors. J Clin Oncol. 2007;25(21):3001-3006. PMID:17548838 DOI:

Schootman M, Jeffe DB, Lian M, Aft R, Gillanders WE. Surveillance mammography and the risk of death among elderly breast cancer patients. Breast Cancer Res Treat. 2008;111(3):489-496. PMID:17957465 DOI:

Lash TL, Fox MP, Silliman RA. Reduced mortality rate associated with annual mammograms after breast cancer therapy. Breast J. 2006;12(1):2-6. PMID:16409580 DOI:

Yang SH, Yang KH, Li YP, et al. Breast conservation therapy for stage I or stage II breast cancer: a meta-analysis of randomized controlled trials. Ann Oncol. 2008;19(6):1039-1044. PMID:18187486 DOI:

Abner AL, Recht A, Eberlein T, et al. Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer. J Clin Oncol. 1993;11(1):44-48. PMID:8418240 DOI:

Montgomery DA, Krupa K, Jack WJ, et al. Changing pattern of the detection of locoregional relapse in breast cancer: the Edinburgh experience. Br J Cancer. 2007;96(12):1802-1807. PMID:17533401 DOI:

Houssami N, Abraham LA, Miglioretti DL, et al. Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA. 2011;305(8):790-799. PMID:21343578 DOI:

Mellink WA, Holland R, Hendriks JH, Peeters PH, Rutgers EJ, van Daal WA. The contribution of routine follow-up mammography to an early detection of asynchronous contralateral breast cancer. Cancer. 1991;67(7):1844-1848.<1844::AID-CNCR2820670705>3.0.CO;2-W PMID:1848469 DOI:<1844::AID-CNCR2820670705>3.0.CO;2-W

Gutter Z. Cancer of the remaining breast: radiologic contribution to diagnosis. Can Med Assoc J. 1976;114(1):27-30. PMID:943222

Senofsky GM, Wanebo HJ, Wilhelm MC, et al. Has monitoring of the contralateral breast improved the prognosis in patients treated for primary breast cancer? Cancer. 1986;57(3):597-602.<597::AID-CNCR2820570334>3.0.CO;2-5 PMID:3942996 DOI:<597::AID-CNCR2820570334>3.0.CO;2-5

Robertson C, Arcot Ragupathy SK, Boachie C, Dixon JM et al. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews registry database analyses and economic evaluation. Health Technol Assess. 2011 Sep;15(34):v-vi, 1-322. PMID: 21951942 DOI:

Orel SG, Fowble BL, Solin LJ, Schultz DJ, Conant EF, Troupin RH. Breast cancer recurrence after lumpectomy and radiation therapy for early-stage disease: prognostic significance of detection method. Radiology. 1993;188(1):189-194. PMID:8511295 DOI:

Ghezzi P; The GIVIO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. JAMA. 1994;271(20):1587-1592. PMID:8182811 DOI:

Rosselli Del Turco M, Palli D, Cariddi A, Ciatto S, Pacini P, Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Project on Breast Cancer follow-up. JAMA. 1994 May 25;271(20):1593-7. PMID:7848404 DOI:

Natoli C, Brocco D, Sperduti I. et al.“FOLLOW-UP” Study Group. Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey. PLoS One. 2014 Apr 8;9(4):e94063. PMID: 24714591 DOI:

Swain SM, Miles D, Kim S-B, et al; CLEOPATRA study group. Pertuzumab, trastuzumab, and docetaxel for HER2-positive metastatic breast cancer (CLEOPATRA): end-of-study results from a double-blind, randomised, placebo-controlled, phase 3 study. Lancet Oncol. 2020;21(4):519-530. PMID:32171426 DOI:

Hortobagyi GN, Stemmer SM, Burris HA, et al. Overall Survival with Ribociclib plus Letrozole in Advanced Breast Cancer. N Engl J Med. 2022;386(10):942-950. PMID:35263519 DOI:

Schmid P, Adams S, Rugo HS, et al; IMpassion130 Trial Investigators. Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med. 2018;379(22):2108-2121. PMID:30345906 DOI:

Emens LA, Adams S, Barrios CH, et al. First-line atezolizumab plus nab-paclitaxel for unresectable, locally advanced, or metastatic triple-negative breast cancer: IMpassion130 final overall survival analysis. Ann Oncol. 2021;32(8):983-993. PMID:34272041 DOI:

Fresco R, Spera G, Meyer C, Cabral P, Mackey JR. Imaging radiation doses and associated risk and benefits in subjects participating in breast cancer clinical trials. Oncologist. 2015;20(7):702-712. PMID:26025934 DOI:

Braun S, Vogl FD, Naume B, et al. A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 2005;353(8):793-802. PMID:16120859 DOI:

Sparano J, O’Neill A, Alpaugh K, et al. Association of circulating tumor cells with late recurrence of estrogen receptor-positive breast cancer: a secondary analysis of a randomized clinical trial. JAMA Oncol. 2018;4(12):1700-1706. PMID:30054636 DOI:

Sant M, Bernat-Peguera A, Felip E, Margelí M. Role of ctDNA in breast cancer. Cancers (Basel). 2022;14(2):310. PMID:35053474 DOI:

Garcia-Murillas I, Schiavon G, Weigelt B, et al. Mutation tracking in circulating tumor DNA predicts relapse in early breast cancer. Sci Transl Med. 2015;7(302):302ra133. PMID:26311728 DOI:

Turner NC, Swift C, Jenkins B, et al; c-TRAK TN investigators. Results of the c-TRAK TN trial: a clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate- and high-risk early-stage triple-negative breast cancer. Ann Oncol. 2023;34(2):200-211. PMID:36423745 DOI:

Percorso DTA. (PDTA) per i pazienti affetti da tumore della mammella - Elaborato dalla Rete Oncologica Veneto (ROV) 2022. (Accessed June 22, 2023)

Hojo T, Masuda N, Mizutani T, et al. Intensive vs. standard post-operative surveillance in high-risk breast cancer patients (INSPIRE): Japan Clinical Oncology Group Study JCOG1204. Jpn J Clin Oncol. 2015;45(10):983-986. PMID:26246481 DOI:

Zamagni C, Gion M, Mariani L, et al. CA15.3 and 18-FDG PET in the follow-up of early breast cancer (BC) patients (pts): A prospective, multicentric, randomized trial—KRONOS patient-oriented new surveillance study Italy. J Clin Oncol. 2017;35(15_suppl):TPS11627. DOI:

Gustafson DH, Shukla RK, Delbecq A, Walster GW. A comparative study of differences in subjective likelihood estimates made by individuals, interacting groups, Delphi groups, and nominal groups. Organ Behav Hum Perform. 1973;9(2):280-291. DOI:

Rowe G, Wright G. Expert opinion in forecasting: role of the Delphi technique. In: Armostrong JS (Ed.), Principles of forecasting. Kluwer Academic Press. 2001; pag 125-126. DOI:



How to Cite

Gori, S., Zambelli, A., Angiolini, C., Ferro, A., De Rose, F., Fabi, A., Azzarello, G., Bogina, G., Cancian, M., Valerio, M., Cinquini, M., Nicolis, F., & Pappagallo, G. (2024). Follow-up of breast cancer: why is it necessary to start a Consensus in 2024?. AboutOpen, 11(1), 10–17.



Point of view


Received 2023-07-10
Accepted 2024-01-16
Published 2024-02-23