Background: In 2012, ASCO’s inaugural "Top 5" list recommended against the routine use of imaging to look for metastases in asymptomatic women with early breast stage cancer. Despite this recommendation being in close agreement with published guidelines, staging imaging is frequently over-utilized. The objective of this study was to determine physicians views on the ASCO "Top 5" and guidelines pertaining to staging imaging for metastatic disease. Methods: A questionnaire was developed and circulated electronically using a modified Dillman technique to Canadian medical, radiation, and surgical oncologists. Results: The questionnaire was completed by 173 physicians (26% response rate). 82% indicated awareness of at least one published guideline on this issue. 60% indicated that they had read the ASCO recommendation and of those, 81% agreed with it. 24% indicated that the ASCO recommendation has influenced them to order less staging imaging. The percentage of respondents who would seldom order imaging for stage 1, 2 and 3 disease was 88%, 37% and 2% respectively. >95% of physicians identified a suspicious history, physical exam, and inflammatory breast cancer as important factors to be taken into consideration when deciding whether or not imaging should be done. The majority did not feel patient demand, fear of litigation or ease of access to imaging were important indications for imaging. Conclusions: Despite awareness of and general agreement with the staging imaging recommendations of the ASCO "Top 5" for early breast cancer, most physicians who treat breast cancer patients have not reduced their use of perioperative imaging. Disease stage, clinical evaluation, and tumour biology were identified as the most important factors influencing their decision of whether to do or not do staging imaging. Alternative strategies, beyond simply publishing recommendations, are therefore required if there is to be a sustained change in physician behaviour.