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Version 2.2015, 03/11/15 © 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®.
MS-1
NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
NCCN Guidelines Version 2.2015
Breast Cancer
Discussion
NCCN Categories of Evidence and Consensus
Category 1:
Based upon high-level evidence, there is uniform NCCN
consensus that the intervention is appropriate.
Category 2A:
Based upon lower-level evidence, there is uniform
NCCN consensus that the intervention is appropriate.
Category 2B:
Based upon lower-level evidence, there is NCCN
consensus that the intervention is appropriate.
Category 3:
Based upon any level of evidence, there is major NCCN
disagreement that the intervention is appropriate.
All recommendations are category 2A unless otherwise noted.
Table of Contents
Overview ........................................................................................................2
Staging ...........................................................................................................2
Pathology Assessment ...................................................................................3
Treatment Approach.......................................................................................5
Pure Noninvasive Carcinomas (Stage 0)........................................................5
Lobular Carcinoma in Situ ..........................................................................5
Ductal Carcinoma in Situ ............................................................................6
Invasive Breast Cancer ................................................................................11
Stage I, IIA, IIB, or T3N1M0 Invasive Breast Cancer....................................11
Staging and Workup .................................................................................11
Locoregional Treatment............................................................................12
Preoperative Systemic Therapy for Large Tumors ...................................16
Radiation Therapy after Mastectomy........................................................20
Breast Reconstruction ..............................................................................21
Systemic Adjuvant Therapy......................................................................24
Post-Therapy Surveillance and Follow-up ................................................40
Stage III Invasive Breast Cancer ..................................................................40
Staging and Workup .................................................................................40
Operable Locally Advanced Breast Cancer ..............................................42
Inoperable Locally Advanced Breast Cancer............................................42
Post-Therapy Surveillance and Follow-up ................................................43
Stage IV Metastatic or Recurrent Breast Cancer..........................................44
Staging and Workup .................................................................................44
Management of Local Disease Only.........................................................45
Management of Stage IV or Recurrent Metastatic Disease ......................46
Surgery for Stage IV or Recurrent Metastatic Disease .............................56
Monitoring Metastatic Disease..................................................................57
Special Situations.........................................................................................58
Paget’s Disease .......................................................................................58
Phyllodes Tumors of the Breast................................................................59
Breast Cancer During Pregnancy .............................................................60
Inflammatory Breast Cancer.....................................................................62
Axillary Breast Cancer ..............................................................................65
Summary......................................................................................................66
References...................................................................................................67
This discussion is being updated to correspond with the
newly updated algorithm. Last updated 04/01/14