Less Frequent Mammography Requires Careful Selection
Roman noted that the update challenges routine practices, including annual mammography for every survivor indefinitely. That flexibility applies to selected patients. For those aged 50 years or older with low-risk features who remain recurrence-free 3 years after diagnosis, surveillance mammography can be offered every 1 to 2 years. This is not a general recommendation to extend intervals for all survivors.2
The Mammo-50 randomized trial enrolled women aged 50 or older at diagnosis who were recurrence-free three years after curative surgery. Less frequent mammography meant every 2 years after breast-conserving surgery or every three years after mastectomy. Five-year breast cancer–specific survival was approximately 98.3% with less frequent surveillance versus 98.1% with annual surveillance, meeting the trial’s noninferiority criterion.3
Those eligibility criteria matter when discussing the findings. Patients should follow their individualized surveillance plan rather than independently postpone an examination.
Follow-Up Can Extend Beyond Oncology
“From a pharmacy perspective, I think one of the biggest things is just awareness that this guideline exists, so that we can help to educate patients and the health care team on appropriate follow-up and surveillance methods for patients,” Roman said.
Selected lower-risk patients can receive annual follow-up through survivorship services or other qualified clinicians, including primary care providers. In-person and virtual visits are options.2 Roman highlighted the potential value of telehealth for eligible patients in rural settings.
Her comments point to a practical pharmacy role: helping patients understand who coordinates follow-up and directing surveillance questions to that clinician. A transition away from frequent oncology appointments should come with a clear explanation of how ongoing care will work.
ctDNA Remains a Research Question
Roman also highlighted growing patient interest in circulating tumor DNA (ctDNA). “We still don’t have prospective randomized clinical trials supporting use of ctDNA in this setting.”
Detecting recurrence risk does not establish that acting on a test result improves outcomes. ESMO’s precision medicine recommendations distinguish the prognostic value of molecular residual disease detection from evidence supporting treatment decisions based on those results.4
The prospective c-TRAK TN trial illustrates the challenge. Among patients allocated to intervention after ctDNA detection, approximately 72% already had metastases on staging scans. Only 5 began pembrolizumab (Keytruda; Merck), and none achieved sustained ctDNA clearance.5 The findings inform further research but do not establish a routine surveillance strategy.
For pharmacists answering patient questions, the distinction is consequential: ctDNA is being studied, while its clinical utility for routine posttreatment breast cancer surveillance remains unproven.2,5
REFERENCES
Nahleh Z, Alfano CM, Somerfield MR, et al. Breast Cancer Follow-Up and Surveillance After Primary Treatment: ASCO Guideline Update. J Clin Oncol. 2026;44(30):2953-2971. doi:10.1200/JCO-26-01700
ASCO breast cancer guidelines. Cleveland Clinic. October 2, 2026. Accessed October 19, 2026.
https://consultqd.clevelandclinic.org/asco-breast-cancer-guidelines Dunn JA, Donnelly P, Elbeltagi N, et al. Annual versus less frequent mammographic surveillance in people with breast cancer aged 50 years and older in the UK (Mammo-50): a multicentre, randomised, phase 3, non-inferiority trial. Lancet. 2025;405(10476):396-407. doi:10.1016/S0140-6736(24)02715-6
Pascual J, Attard G, Bidard FC, et al. ESMO recommendations on the use of circulating tumour DNA assays for patients with cancer: a report from the ESMO Precision Medicine Working Group. Ann Oncol. 2022;33(8):750-768. doi:10.1016/j.annonc.2022.05.520
Turner NC, Swift C, Jenkins B, et al. 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. doi:10.1016/j.annonc.2022.11.005
