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A large number of medical societies have issued recommendations for follow-up after primary treatment for early breast cancer, which mostly differ only in the details. The central statement in all of these guidelines has been based on two studies that were published in 1994 and came under criticism due to methodological flaws and the lack of modern diagnostic tools. This statement contains the merely symptom-induced search for distant metastasis and the rejection of routine imaging procedures and biomarker analyses in the follow-up process. Prospective, randomized and optimally designed trials are necessary to re-evaluate this dogma in view of the diagnostic and treatment progress since that time. The prognosis of mono- and oligometastatic disease diagnosed in this connection could lead to long-term survival. Presently, the existing guidelines should be followed accurately. The objectives of follow-up include early detection of local–regional recurrences and contralateral breast cancer, the management of treatment side effects and toxicities, motivation of patients to comply, psychosocial rehabilitation and lifestyle counseling with regard to the improvement of breast cancer prognosis. In conclusion, breast cancer survivors require comprehensive follow-up management based on evidence, whenever possible.