A Canadian population-based analysis showed that the mean number of visits in the first 5 years after primary treatment was usually higher than recommended

by the ASCO guidelines. For example, during the second year patients underwent a mean of 11.2 visits by different physicians, including PCP, medical oncologist, radiation oncologist, surgeon and others, compared with 2–4 visits recommended [19]. These numbers are a common result of a widespread duplication of care. In line with these results, Keating and Colleagues observed that 13.3% of GSI-IX cell line the 37,967 patients collected in the Surveillance, Epidemiology, and End Results (SEER) – Medicare database had at least one bone scan, 29.2% had a tumor antigen test, 10.9% had chest/abdominal imaging, and 58.8% had a chest X-ray in the first year of follow-up, and patients followed by medical and radiation oncologists had the highest chance of undergoing non-recommended tests [20]. Similarly, a National survey conducted among Italian medical oncologists showed an abuse of imaging and tumor markers test in asymptomatic BC survivors [21]. There are multiple possible reasons of overuse of imaging and laboratory testing. The first one is the patient-driven

anxiety and the feeling of reassurance induced by Adriamycin cell line examinations. Patients are prone to associate the frequency of clinical examinations and testing with improved outcomes [22] Isoconazole due to the unrealistic belief that more testing could anticipate the diagnosis of recurrence and improve treatment outcomes. A second issue to

be taken into account is the dearth of prospective trials with new generation imaging (CT and PET scans) or oriented to special populations (for example women under 40 years old or patients with triple-negative or HER2-positive disease). Finally, an important trigger of unnecessary examinations and visits may be the absence of a clear coordination among all the professionals involved in the survivorship plan [23]. By contrast, uncoordinated care can also be the cause of underuse of appropriate visits and tests: the SEER data [20] showed that in United States only 27% of breast cancer survivors’ aged 65 years or older saw their oncologists annually for 3 years after active treatment and a case control study conducted in Ontario [24] highlighted that among BC survivors only a minority underwent colorectal and cervical cancer screening, despite being seen by multiple specialists during the first 5 years after primary treatment. These examples of lower-than-standard practice support the hypothesis that resources may not be equally distributed among surviving patients. A huge amount of evidence suggests that the risk of BC recurrence and death is influenced not only by stage at initial presentation but also by the underlying biology of the tumor [25]. Overall, the hazard rate varies over time according to predictive and prognostic factors [25].