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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
®
.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
BINV-9
NCCN Guidelines Version 2.2015
Invasive Breast Cancer
SYSTEMIC ADJUVANT TREATMENT - FAVORABLE HISTOLOGIES
w
Evidence supports that the magnitude of benefit from surgical or radiation ovarian ablation in premenopausal women with hormone receptor-positive breast cancer
is similar to that achieved with CMF alone. Early evidence suggests similar benefits from ovarian suppression (ie, LHRH agonist) as from ovarian ablation.
The combination of ovarian ablation/suppression plus endocrine therapy may be superior to suppression alone. The benefit of ovarian ablation/suppression in
premenopausal women who have received adjuvant chemotherapy is uncertain.
x
Chemotherapy and endocrine therapy used as adjuvant therapy should be given sequentially with endocrine therapy following chemotherapy. Available data suggest
that sequential or concurrent endocrine therapy with radiation therapy is acceptable.
y
There are limited data to make chemotherapy recommendations for those >70 y old. Treatment should be individualized with consideration of comorbid conditions.
cc
If ER-positive, consider endocrine therapy for risk reduction and to diminish the small risk of disease recurrence.
Histology:
• Tubular
• Mucinous
ER-positive
and/or
PR-positive
ER-negative
and
PR-negative
pT1, pT2, or pT3;
and pN0 or pN1mi
(≤2 mm axillary
node metastasis)
Node positive (one or more
metastases >2 mm to one or more
ipsilateral axillary lymph nodes)
Repeat determination
of ER/PR status
<1 cm
1–2.9 cm
≥3 cm
ER-positive
and/or
PR-positive
ER-negative
and
PR-negative
No adjuvant therapy
cc
Consider adjuvant endocrine
therapy
w
Adjuvant endocrine therapy
w
Adjuvant endocrine therapy
w
± adjuvant chemotherapy
x,y
Follow appropriate
pathway above
Treat as usual breast cancer
histology
(
See BINV-7
and
BINV-8
)
See Follow-Up
(BINV-16)
See Adjuvant Endocrine Therapy (BINV-J)
and
Neoadjuvant/Adjuvant Chemotherapy (BINV-K)