Hello,  I am not a researcher.  I am a former cancer survivor now battling metastatic breast cancer to the liver and peritoneum.  I read your short article about how ASCO is not adjusting their recommendations for follow up.  I am a member of a large, well known HMO and I had my primary cancer, ER+ invasive ductal ca, in 1997.  I had the advised treatment of sentinel node biopsy/lumpectomy with radiation.  There was no ca cells found in the three nodes they removed and they got clear margins at the lumpectomy site.  I have had the recommended f/u care ever since.
That was 15 years ago.  I elected not to take Tamoxifen at the time because I was pre menopausal and the risks did not outweigh the benefits.
My problem with the current recommended f/u care is that it missed my cancer.  And probably for a long time.  My primary cancer, a slow growing cancer, which is the same cancer I have now would probably have been caught many years ago had my HMO not followed recommended guidelines.
I say this because every year my regular bloodwork, mammogram, and physical exam were all normal.  I am a relatively healthy person and my current doctor says that my body has tolerated the current cancer inspite of how extensive it is.  Had my doctors routinely done other tests like scans and tumor markers even though there was not an apparent problem, I believe that I would not be facing the prognosis that I am facing now.
And because I don't believe that I am the only person in this situation, I think you do need to reevaluate your guidelines.  I am going to check with my current oncologist when I see him again in a couple of weeks to find out if in fact my HMO does follow your guidelines or if they have some other protocol of their own.  At any rate, I think the accepted f/u guidelines should include all the tests necessary to "leave no stone unturned" for anyone facing primary breast cancer of the breast.  Thank you.