Background The major goal of routine follow‐up in oropharyngeal squamous cell carcinoma (OPSCC) patients is the asymptomatic detection of new disease in order to improve survival. This study evaluated the effect of routine follow‐up on overall survival (OS). Methods A retrospective cohort of 307 consecutive OPSCC patients treated with curative intent between 2006 and 2012 was analyzed. The effectiveness of routine follow‐up was studied by comparing treatment‐intent and OS in patients with asymptomatically versus symptomatically detected new disease. Results Three‐ and five‐year risks of new disease were 29% (95% CI: 24–34) and 33% (95% CI: 27–39). Of the 81 patients with locoregional recurrence or second primary head and neck cancer, 8 (10%) were detected asymptomatically with no difference in OS with those detected with symptoms. Conclusions Asymptomatic detection of new disease during routine visits was not associated with improved OS. The focus of follow‐up should be on providing psychosocial care and rehabilitation.