TABLE 4-6Treatment and Allocation of Resources: Locally Advanced Breast Cancer Guidelines

Level of ResourcesLocal-Regional Treatment Systemic Treatment (Adjuvant)
SurgeryRadiation TherapyChemotherapyEndocrine Therapy
BasicModified radical mastectomyNeoadjuvant AC, FAC, or classical CMFaOvarian ablation Tamoxifen
LimitedPostmastectomy irradiation of the chest wall and regional nodes
EnhancedBreast-conserving therapybBreast-conserving whole-breast irradiationTaxanesAromatase inhibitors
LH-RH agonists
MaximalReconstructive surgeryGrowth factors
Dose-dense chemotherapy

AC = doxorubicin and cyclophosphamide; FAC = 5-fluorouracil, doxorubicin, and cyclophosphamide; CMF = cyclophosphamide, methotrexate, and 5-fluorouracil; EC = epirubicin and cyclophosphamide; LH-RH = luteinizing hormone-releasing hormone.


Requires blood chemistry profile and complete blood count testing.


Breast-conserving therapy requires mammography and reporting of margin status.

SOURCE: Reprinted, by permission, from Anderson et al. (2006a). Copyright 2006 by the Breast Health Global Initiative, Fred Hutchinson Cancer Research Center.

From: 4, Defining Resource-Level-Appropriate Cancer Control

Cover of Cancer Control Opportunities in Low- and Middle-Income Countries
Cancer Control Opportunities in Low- and Middle-Income Countries.
Institute of Medicine (US) Committee on Cancer Control in Low- and Middle-Income Countries; Sloan FA, Gelband H, editors.
Washington (DC): National Academies Press (US); 2007.
Copyright © 2007, National Academy of Sciences.

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