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After completing curative-intent cancer treatment, millions of survivors undergo years of routine scans and blood tests aimed at catching cancer recurrences early. While this practice is widely recommended by medical guidelines, a growing number of experts are questioning whether these routine checks truly benefit patients who show no symptoms—and whether they may, in fact, cause harm.
The Debate: Benefit vs. Harm
Routine surveillance, including imaging scans and blood-based tumor-marker tests, is common for survivors of many solid tumors. For example, colon cancer survivors may be scanned every six months for five years, and prostate cancer patients are often monitored annually with PSA tests. The rationale is straightforward: catching a recurrence early, when the tumor burden is lower, could improve the chances of successful treatment and survival.
However, recent perspectives published in leading medical journals challenge this assumption. Dr. H. Gilbert Welch and Dr. Lesly A. Dossett, writing in The New England Journal of Medicine, argue that while routine surveillance detects more recurrences, it does not reduce mortality and often brings financial, physical, and psychological burdens. They conclude, “less surveillance would be better for patients.”
Dr. Kathy D. Miller, a breast cancer expert, agrees that the value of surveillance in asymptomatic patients is questionable. She emphasizes that unless new evidence emerges showing improved outcomes, routine testing risks causing more harm than good.
What Do Guidelines Say?
Most specialty societies, including the American Society of Clinical Oncology (ASCO), recommend against routine imaging or tumor-marker testing for asymptomatic patients after curative treatment for solid tumors—unless strong evidence shows a benefit. Yet, guidelines often still endorse routine surveillance, even when the survival benefit is unclear. For instance:
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Colon cancer: Guidelines support imaging after curative treatment, but recent data show no survival benefit.
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Prostate cancer: Annual PSA testing is recommended despite high long-term survival rates.
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Non-small cell lung cancer: Routine imaging is advised, though evidence for improved survival is lacking.
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Pancreatic cancer: Guidelines are inconsistent due to a lack of randomized data.
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Breast cancer: ASCO and NCCN recommend against routine surveillance for metastatic disease in asymptomatic patients, but many physicians still order scans in practice.
Weighing the Evidence
The theoretical argument for routine surveillance is strong—early detection could mean more effective treatment. Some data show better five-year survival for patients with asymptomatic recurrences. However, experts caution that this may reflect “lead-time bias,” where survival appears longer simply because the cancer was detected earlier, not because patients actually live longer1.
A 2021 systematic review of 12 randomized controlled trials found no statistically significant mortality benefit from imaging-based surveillance in asymptomatic patients across several solid tumors. In other words, finding and treating recurrences before symptoms develop did not improve overall survival compared to waiting until symptoms appeared.
Potential Harms of Routine Surveillance
Routine surveillance is not without risks. Scans and blood tests can provoke anxiety, fuel fears of recurrence, and lead to further tests due to incidental findings, increasing radiation exposure and costs. Many of these costs are borne by patients, and the time spent on surveillance can take away from work and family life.
Experts argue that patients may not choose routine surveillance if they were fully informed about the lack of mortality benefit and the potential for harm1. There is also concern that current guidelines do not adequately consider the risk-benefit ratio, nor do they ensure patients are part of the decision-making process.
Personalized Approaches and New Technologies
Some clinicians believe that surveillance should be individualized, taking into account cancer type, genetics, and patient preferences. For example, lung cancer progresses quickly, and early detection may be more beneficial in this context1.
Emerging technologies like circulating tumor DNA (ctDNA) testing offer new, less invasive ways to detect minimal residual disease. While promising, experts caution that widespread adoption should wait until randomized trials show that early detection through ctDNA testing actually improves survival or quality of life.
Conclusion
The debate over routine surveillance after curative cancer treatment highlights the need for patient-centered care and critical evaluation of current guidelines. While routine checks may offer peace of mind to some, the evidence does not support a clear survival benefit for asymptomatic patients—and the potential harms are real.
“The onus is on clinicians to critically evaluate guideline recommendations and to clearly communicate the harms vs benefits of routine surveillance to patients,” advise experts in oncology.
Disclaimer:
This article summarizes current research and expert opinion as of June 2025 and is intended for informational purposes only. It should not be interpreted as medical advice. Patients should consult their healthcare providers to discuss the best surveillance strategy for their individual circumstances.
