Breast Cancer Treatment Guidelines

Introduction to Breast Cancer Treatment

The European Society for Medical Oncology recommends that treatment must be delivered by a specialized multidisciplinary breast team and should be based on tumor biology, tumor burden, and patient factors 1, 2

The American Society of Clinical Oncology states that a medical oncologist, breast surgeon, radiation oncologist, breast radiologist, breast pathologist, and breast nurse or specialized navigator are mandatory for optimal breast cancer care 1, 3
Access to plastic/reconstructive surgeons, psychologists, physiotherapists, and geneticists must be available when appropriate 1, 3

The American College of Surgeons recommends breast-conserving surgery with radiation as the preferred surgical approach for the majority of early breast cancer patients, as it provides equivalent survival to mastectomy with superior quality of life 1, 2, 4
The National Comprehensive Cancer Network states that immediate breast reconstruction should be offered to the vast majority of mastectomy patients, except those with inflammatory cancer 1, 5

The American Society for Radiation Oncology recommends whole breast radiation therapy after lumpectomy, as it substantially reduces local recurrence and improves survival 4
The European Society for Radiotherapy and Oncology states that radiation boost to tumor bed is standard for patients under 50 years, and should be considered for patients over 50 with risk factors 4

The National Comprehensive Cancer Network recommends that for premenopausal women with lymph node involvement, chemotherapy and tamoxifen is the standard, while for postmenopausal women, tamoxifen is the standard 6, 7, 8
The American Society of Clinical Oncology states that for HER2-positive disease, concurrent taxane and anti-HER2 therapy is required, and anthracycline-based chemotherapy should be incorporated in the treatment regimen 9, 4

The National Society of Genetic Counselors recommends that every patient with bilateral breast cancer should be offered genetic counseling, preferably before starting treatment, and testing should include BRCA1/2 as primary targets 10

The American College of Surgeons states that information on diagnosis and treatment must be given repeatedly, both verbally and in writing, in a comprehensive and easily understandable form, and patients must be actively involved in all management decisions 1, 2

The European Society for Medical Oncology recommends that age should be taken into consideration in conjunction with other factors and should NOT be the sole determinant for withholding or recommending treatment 1, 3, 2

The National Comprehensive Cancer Network states that omitting radiation therapy after breast-conserving surgery, performing routine axillary dissection when sentinel lymph node biopsy is negative, accepting positive surgical margins, delaying endocrine therapy in hormone receptor-positive disease, using tamoxifen alone in premenopausal women with lymph node-positive disease, and performing genetic testing without adequate pre-test counseling should be avoided 4, 6, 7, 8, 10