Management of Early Breast Cancer

Contents......Page 6
About the guideline......Page 11
Summary......Page 15
Breast cancer epidemiology......Page 36
Risk factors......Page 38
Communication and information provision......Page 40
Psychosocial support......Page 44
Role of multidisciplinary team and identified coordinator of care......Page 48
Considerations for Maori and Pacific peoples......Page 50
Routine staging investigations......Page 56
Preoperative magnetic resonance imaging......Page 60
Mastectomy versus breast conserving surgery and radiotherapy......Page 64
Margins of excision for breast conserving surgery......Page 70
Management of the axilla in invasive breast cancer: effectiveness of nodal excision......Page 72
Diagnostic accuracy of sentinel lymph node biopsy......Page 76
Effectiveness of sentinel lymph node biopsy compared with axillary dissection......Page 82
Axillary clearance after sentinel lymph node biopsy......Page 86
Breast reconstruction......Page 88
4.1 Advantages and disadvantages of immediate compared with delayed breast reconstruction......Page 90
Radiotherapy in addition to breast conserving surgery......Page 94
Radiotherapy in addition to mastectomy......Page 96
Addition of boost dose of radiotherapy to radiotherapy and mastectomy......Page 100
Fractionation schedules......Page 102
Hypofractionated radiotherapy......Page 104
Nodal irradiation......Page 108
Adjuvant therapy......Page 112
Anthracycline-based regimens......Page 114
Taxane-based regimens......Page 116
Trastuzumab-based regimens......Page 120
6.6 Main results of additional study evaluating trastuzumab in HER2-positive early breast cancer......Page 132
Introduction......Page 136
Accuracy of oestrogen and progesterone receptor scores......Page 138
Endocrine therapy as an adjunct to chemotherapy......Page 140
Addition of chemotherapy to endocrine therapy ± surgery ± radiotherapy......Page 144
7.2 Recommended treatment options in postmenopausal women based on endocrine responsiveness and risk of relapse......Page 150
Aromatase inhibitors......Page 152
Role of adjuvant bisphosphonates: survival......Page 162
Role of adjuvant bisphosphonates: bone density......Page 164
Surgical management for ductal carcinoma in situ......Page 168
Radiotherapy in addition to breast surgery for ductal carcinoma in situ......Page 174
Systemic therapy: endocrine therapy......Page 176
Radiological follow-up......Page 178
Clinical follow-up: hospital-based versus general practice......Page 180
Genetic testing......Page 184
Prophylactic treatment......Page 188
Pregnancy......Page 190
Participation in clinical trials......Page 192
Other specific issues......Page 194
Methods......Page 196
Evidence and recommendation grading system......Page 202
Guideline Development Team......Page 204
Declarations of competing interests......Page 206
Appendices......Page 208
A: TNM classification......Page 210
B: Verbal prompts to assist when raising specific concerns with people with cancer......Page 214
D: Pathology guidance for early management of breast cancer......Page 216
E: Prognostic tools......Page 222
F1 Definition of risk categories......Page 224
Abbreviations......Page 226
Glossary......Page 228
References......Page 234
List of boxes......Page 10
4.1 Randomised trials comparing mastectomy with breast conserving surgery and radiotherapy......Page 66
4.2 Randomised trials comparing sentinel lymph node biopsy with axillary lymph node dissection reported in the National Breast and Ovarian Cancer Centre guideline......Page 78
4.3 Accuracy of sentinel lymph node biopsy......Page 80
5.1 Early follow-up data (five years) for clinical outcomes following different fractionation schedules......Page 106
6.2 Trials using sequential regimens......Page 118
6.4 Main outcomes reported from key trials evaluating trastuzumab in HER2-positive early breast cancer......Page 126
6.5 Key results from the three meta-analyses evaluating trastuzumab in HER2-positive early breast cancer......Page 130
7.1 Summary of key randomised controlled trials comparing tamoxifen and aromatase inhibitors – upfront, switching, sequential and extended therapy regimens......Page 160
A1 Stage grouping for breast cancer......Page 212
2.1 Checklist to identify cancer patients at a higher risk of psychosocial distress......Page 46
2.2 Specific examples of barriers to care from a Maori perspective......Page 52
7.1 Recommended treatment options in premenopausal women based on endocrine responsiveness and risk of relapse......Page 148