NCCN VERSION 2 2015

NCCN Guidelines Version 2.2015 Breast Cancer

NCCN Guidelines Index Breast Cancer Table of Contents Discussion

Discussion

This discussion is being updated to correspond with the newly updated algorithm. Last updated 04/01/14

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

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

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