Modern international guidelines for the management of patients after completion of breast cancer treatment: an evidencebased review

Background. Advances in breast cancer (BC) treatment have led to a large and growing population of survivors. This necessitates a clinical paradigm shift from a sole focus on survival to the comprehensive management of long-term health and quality of life. Objective. To critically analyze and synthesize current evidence-based data on key aspects of post-treatment BC care, emphasizing the transition from passive surveillance to proactive strategies for rehabilitation and secondary prevention. Materials and methods. A systematic analysis of data from key randomized clinical trials (RCTs), meta-analyses (Cochrane, EBCTCG), and clinical guidelines (ESMO, NCCN) was conducted. The review covers the efficacy of follow-up protocols, the impact of lifestyle factors, methods for managing endocrine therapy complications, and modern approaches to fertility preservation. Results. The analysis reveals a scientific consensus on the inefficacy of intensive instrumental screening in asymptomatic patients. Conversely, the role of lifestyle modification is strongly evidenced, with body weight control and regular physical activity being key factors in reducing the risk of recurrence and mortality. Managing long-term complications of endocrine therapy, such as osteoporosis and genitourinary syndrome, requires a proactive approach, including the use of bone-modifying agents (which also possess antitumor effects) and safe methods of local hormonal treatment. The POSITIVE trial represents a breakthrough in oncofertility, proving the safety of temporarily interrupting therapy to pursue pregnancy, which fundamentally changes counseling for young patients. Conclusion. The modern concept of BC survivorship care demands a shift towards personalized survivorship care plans. These plans must integrate evidence-based surveillance strategies, proactive management of side effects, mandatory screening and correction of psychological distress, and active patient engagement in lifestyle modification. Future research should focus on developing effective models for implementing these comprehensive approaches into routine clinical practice.