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The most important element in early breast cancer patient follow-up is to detect recurrences and adverse effects of treatment at a time point when intervention leads to a clinically significant outcome for the patient. The delicate balance, between required versus over-surveillance that may lead to unnecessary burden for the patient and the health system should be considered. In this debate we discuss the evidence for follow up of high-risk breast cancer patients, and how intensive follow-up might not necessarily lead to a better outcome.