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National Collaborating Centre for Cancer (UK). Early and Locally Advanced Breast Cancer: Diagnosis and Treatment [Internet]. Cardiff (UK): National Collaborating Centre for Cancer (UK); 2009 Feb. (NICE Clinical Guidelines, No. 80.)

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Early and Locally Advanced Breast Cancer: Diagnosis and Treatment [Internet].

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Key priorities

  1. Offer MRI of the breast to patients with invasive breast cancer:
    • – if there is discrepancy regarding the extent of disease from clinical examination, mammography and ultrasound assessment for planning treatment
    • – if breast density precludes accurate mammographic assessment
    • – to assess the tumour size if breast conserving surgery is being considered for invasive lobular cancer.
  2. Pretreatment ultrasound evaluation of the axilla should be performed for all patients being investigated for early invasive breast cancer and, if morphologically abnormal lymph nodes are identified, ultrasound-guided needle sampling should be offered.
  3. Minimal surgery, rather than lymph node clearance, should be performed to stage the axilla for patients with early invasive breast cancer and no evidence of lymph node involvement on ultrasound or a negative ultrasound-guided needle biopsy. SLNB is the preferred technique.
  4. Discuss immediate breast reconstruction with all patients who are being advised to have a mastectomy, and offer it except where significant comorbidity or (the need for) adjuvant therapy may preclude this option. All appropriate breast reconstruction options should be offered and discussed with patients, irrespective of whether they are all available locally.
  5. Start adjuvant chemotherapy or radiotherapy as soon as clinically possible within 31 days of completion of surgery1 in patients with early breast cancer having these treatments.
  6. Postmenopausal women with ER-positive early invasive breast cancer who are not considered to be at low risk2 should be offered an aromatase inhibitor, either anastrozole or letrozole, as their initial adjuvant therapy. Offer tamoxifen if an aromatase inhibitor is not tolerated or contraindicated.
  7. Patients with early invasive breast cancer should have a baseline dual energy X-ray absorptiometry (DEXA) scan to assess bone mineral density if they:
    • – are starting adjuvant aromatase inhibitor treatment
    • – have treatment-induced menopause
    • – are starting ovarian ablation/suppression therapy.
  8. Treat patients with early invasive breast cancer, irrespective of age, with surgery and appropriate systemic therapy, rather than endocrine therapy alone, unless significant comorbidity precludes surgery.
  9. Offer annual mammography to all patients with early breast cancer, including DCIS, until they enter the NHSBSP/BTWSP. Patients diagnosed with early breast cancer who are already eligible for screening should have annual mammography for 5 years.
  10. Patients treated for breast cancer should have an agreed, written care plan, which should be recorded by a named healthcare professional (or professionals), a copy sent to the GP and a personal copy given to the patient. This plan should include:
    • – designated named healthcare professionals
    • – dates for review of any adjuvant therapy
    • – details of surveillance mammography
    • – signs and symptoms to look for and seek advice on
    • – contact details for immediate referral to specialist care, and
    • – contact details for support services, for example support for patients with lymphoedema.

Department of Health (2007). Cancer reform strategy. London: Department of Health. (At present no equivalent target has been set by the Welsh Assembly Government.)

Low-risk patients are those in the EPG or GPG groups in the Nottingham Prognostic Index (NPI) who have a 10 year predictive survival of 96% and 93% respectively. They would have a similar prediction using Adjuvant! Online. High-risk patients are those in groups PPG with 53% or VPG with 39%.

Footnotes

1

Department of Health (2007). Cancer reform strategy. London: Department of Health. (At present no equivalent target has been set by the Welsh Assembly Government.)

2

Low-risk patients are those in the EPG or GPG groups in the Nottingham Prognostic Index (NPI) who have a 10 year predictive survival of 96% and 93% respectively. They would have a similar prediction using Adjuvant! Online. High-risk patients are those in groups PPG with 53% or VPG with 39%.

Copyright © 2009, National Collaborating Centre for Cancer.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licenses issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Bookshelf ID: NBK11627
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