The ASCO guidelines for postoperative follow-up and management of breast cancer were developed and published in 1997, updated twice in 1999 and 2006, and updated in 2012 in the Journal of Clinical Oncology (J Clin Oncol), published online on November 5, 2012. In patients taking tamoxifen, pelvic examination is also required, while bone imaging, hematological examination including tumor marker examination and CT are not recommended as routine follow-up examinations. The international multicenter clinical research projects in China have followed the recommended follow-up method. The frequency of follow-up examinations should be parallel to the risk of recurrence. Patients with breast cancer within 3 years after surgery have a higher risk of recurrence and metastasis, and the follow-up interval is shorter, generally every 3-6 months, and every 6-12 months within 3-5 years; patients with more than 5 years after surgery have a significantly lower risk of tumor recurrence and metastasis, and the follow-up interval can be appropriately extended to once a year. The purpose of breast cancer follow-up is to bring benefits to patients in terms of longer survival and better quality of life. It also provides early detection of recurrence and metastasis, second primary tumor and treatment-related complications to guide recovery. Another purpose of follow-up is to accumulate information on the natural course of disease, treatment efficiency and treatment side effects. Although follow-up is beneficial to both patients and physicians, there are disadvantages to frequent and excessive follow-up. Patients return to normal social life after treatment, and each follow-up visit reminds patients of the fact that cancer can recur at any time; patients may be worried and nervous before the test results are available, and bad emotions may sometimes be related to recurrence and metastasis, and may reduce patients’ quality of life; X-rays, CT, and bone imaging increase patients’ exposure to radiation, which may increase the risk of tumor development. In addition, excessive follow-up examinations increase the financial burden of patients and society. Most physicians and patients tend to believe that aggressive detection and treatment of recurrence and metastasis prolongs patient survival and reduces treatment complications; however, current studies do not support these findings. Two multicenter randomized controlled studies have also demonstrated no survival advantage for patients with enhanced follow-up examinations. The enhanced follow-up included relatively costly tests such as chest X-ray, abdominal ultrasound, serum tumor markers, and bone imaging; the minimal follow-up included less costly tests such as physical examination and mammogram. The results showed that the enhanced follow-up group detected bone and lung metastases earlier and had shorter disease-free survival, but overall survival was not improved. The investigators concluded that enhanced follow-up for metastases and recurrence would not provide a survival benefit in clinical practice. The reason that enhanced follow-up of lesions that were found to have a survival benefit after reasonable follow-up did not provide a better benefit to patients than minimal follow-up may be that some lesions, even when detected early, do not provide the same benefit. The lesions that provide a survival benefit with early detection at follow-up include local recurrence, second primary breast cancer, and endometrial cancer. These lesions can be detected with minimal follow-up. For example, ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery can be detected early by physical examination and mammogram, and recurrence after partial mastectomy can be detected by physical examination alone; breast cancer patients are at increased risk of developing second primary tumors after treatment, and screening for second primary breast cancer requires only physical examination and annual mammogram without excessive adjuvant testing; tamoxifen treatment increases the risk of endometrial cancer, especially for patients over 50 years of age, but endometrial cancer has early symptoms of abnormal vaginal bleeding, making early diagnosis and early treatment possible. Early detection of lesions can be achieved by annual or abnormal bleeding with pelvic examination, and routine endometrial biopsy is not necessary. Clinical research found that 2/3 of patients with recurrence or metastasis have corresponding clinical manifestations before diagnosis. For example, patients with liver metastasis may have discomfort or pain in the liver area and hepatomegaly; patients with bone metastasis may have pain at the metastatic site. For lymph node metastasis, which is more common in breast cancer patients, it can be detected and treated through physical examination. Some studies have shown that serum tumor marker test has low sensitivity for detecting breast cancer recurrence and is not included as a routine test. Therefore, there is little significance in performing enhanced follow-up.