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<meta name="robots" content="NOINDEX,NOFOLLOW,NOARCHIVE,NOIMAGEINDEX" /><meta name="author" content="National Collaborating Centre for Cancer (UK)" /><meta name="citation_title" content="Early and Locally Advanced Breast Cancer" /><meta name="citation_publisher" content="National Collaborating Centre for Cancer (UK)" /><meta name="citation_date" content="2009/02" /><meta name="citation_author" content="National Collaborating Centre for Cancer (UK)" /><meta name="citation_pmid" content="20704053" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK11643/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Early and Locally Advanced Breast Cancer" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Collaborating Centre for Cancer (UK)" /><meta name="DC.Contributor" content="National Collaborating Centre for Cancer (UK)" /><meta name="DC.Date" content="2009/02" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK11643/" /><meta name="description" content="Update Information: In July 2018 we updated and replaced this guideline with NICE guideline NG101 on early and locally advanced breast cancer." /><meta name="og:title" content="Early and Locally Advanced Breast Cancer" /><meta name="og:type" content="book" /><meta name="og:description" content="Update Information: In July 2018 we updated and replaced this guideline with NICE guideline NG101 on early and locally advanced breast cancer." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK11643/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg80-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="warning" content="Update information: In July 2018 we updated and replaced this guideline with NICE guideline NG101 on early and locally advanced breast cancer. Some of the 2009 recommendations have been retained in the new guideline. This 2009 full guideline includes the evidence supporting the 2009 recommendations. Information that has been replaced by the new guideline has been shaded in grey in the PDF." /><meta name="bk-non-canon-loc" content="/books/n/nicecg80/toc/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK11643/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p></div><div class="bk_msg_box bk_bttm_mrgn clearfix bk_noprnt"><div class="iconblock clearfix"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/niceng101/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng101-lrg.png" alt="Cover" height="100px" width="80px" /></a><div class="icnblk_cntnt"><ul class="messages"><li class="info icon"><span class="icon"><a href="/books/n/niceng101/">A new version of this title is available</a></span></li></ul></div></div></div><div class="messagearea bk_noprnt" style="margin-bottom:1.3846em "><ul class="messages"><li class="warn icon"><span class="icon">Update information: In July 2018 we updated and replaced this guideline with NICE guideline NG101 on early and locally advanced breast cancer. Some of the 2009 recommendations have been retained in the new guideline. This 2009 full guideline includes the evidence supporting the 2009 recommendations. Information that has been replaced by the new guideline has been shaded in grey in the PDF.</span></li></ul></div><div class="bk_prnt"><p style="color:red;"><strong>Update information: In July 2018 we updated and replaced this guideline with NICE guideline NG101 on early and locally advanced breast cancer. Some of the 2009 recommendations have been retained in the new guideline. This 2009 full guideline includes the evidence supporting the 2009 recommendations. Information that has been replaced by the new guideline has been shaded in grey in the PDF.</strong></p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="http://www.wales.nhs.uk/sites3/home.cfm?OrgID=432" title="National Collaborating Centre for Cancer (UK)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg80-lrg.png" alt="Cover of Early and Locally Advanced Breast Cancer" /></a><div class="icnblk_cntnt"><h1 id="_NBK11643_"><span itemprop="name">Early and Locally Advanced Breast Cancer</span></h1><div class="subtitle">Diagnosis and Treatment</div><p><i>NICE Clinical Guidelines, No. 80</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Collaborating Centre for Cancer (UK)</span>.</p><div class="half_rhythm">Cardiff (UK): <a href="http://www.wales.nhs.uk/sites3/home.cfm?OrgID=432" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Collaborating Centre for Cancer (UK)</span></a>; <span itemprop="datePublished">2009 Feb</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-0-9558265-2-8</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © 2009, National Collaborating Centre for Cancer.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div itemprop="description"><h2>Excerpt</h2><p><b>Update Information:</b> In July 2018 we updated and replaced this guideline with NICE guideline NG101 on early and locally advanced breast cancer.</p><p>Breast cancer is the most common cancer in women and its management often presents patients
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and their healthcare professionals with difficult decisions about the most appropriate
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||
treatment. For all those affected by breast cancer (including family and carers) it is
|
||
important to recognise the impact of this diagnosis, the complexity of treatment options and
|
||
the wide ranging needs and support required throughout this period of care and beyond. We
|
||
hope that this document will provide helpful and appropriate guidance to both healthcare
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professionals and patients on the diagnosis and subsequent management of early and locally
|
||
advanced breast cancer.</p></div><div><h2>Contents</h2><ul id="toc_tllNBK11643_toc_foreword" class="simple-list toc toc-toggle"><li class="half_rhythm" id="toc_itm_NBK11643_toc_foreword"><a class="toc-item" href="/books/n/nicecg80/foreword/">Foreword</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_kprior"><a class="toc-item" href="/books/n/nicecg80/kprior/">Key priorities</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_keyrec"><a class="toc-item" href="/books/n/nicecg80/keyrec/">Key research recommendations</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_rec"><a class="toc-item" href="/books/n/nicecg80/rec/">Recommendations</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_meth"><a class="toc-item" href="/books/n/nicecg80/meth/">Methodology</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_algor"><a class="toc-item" href="/books/n/nicecg80/algor/">Algorithm</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1"><a class="toc-item" href="/books/n/nicecg80/ch1/">1. Epidemiology</a><ul id="toc_lst_NBK11643_toc_ch1" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s1"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s1">1.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s2"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s2">1.2. Incidence</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s4"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s4">1.3. Prognosis</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s5"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s5">1.4. Mortality</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s7"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s7">1.5. Survival</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s8"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s8">1.6. Prevalence</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s9"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s9">1.7. Treatment</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s17"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s17">1.8. Summary</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_s18"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.s18">1.9. Summary of findings from breast cancer teams peer review in England 2004–2007</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch1_rl1"><a class="toc-item" href="/books/n/nicecg80/ch1/#ch1.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch2"><a class="toc-item" href="/books/n/nicecg80/ch2/">2. Referral, diagnosis, preoperative assessment and psychological support</a><ul id="toc_lst_NBK11643_toc_ch2" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch2_s1"><a class="toc-item" href="/books/n/nicecg80/ch2/#ch2.s1">2.1. Introduction to Breast Cancer</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch2_s2"><a class="toc-item" href="/books/n/nicecg80/ch2/#ch2.s2">2.2. Referral and Diagnosis</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch2_s3"><a class="toc-item" href="/books/n/nicecg80/ch2/#ch2.s3">2.3. Preoperative Assessment of the Breast and Axilla</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch2_s11"><a class="toc-item" href="/books/n/nicecg80/ch2/#ch2.s11">2.4. Preoperative Staging of the Axilla</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch2_s14"><a class="toc-item" href="/books/n/nicecg80/ch2/#ch2.s14">2.5. Providing Information and Psychological Support</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch2_rl1"><a class="toc-item" href="/books/n/nicecg80/ch2/#ch2.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch3"><a class="toc-item" href="/books/n/nicecg80/ch3/">3. Surgery for early breast cancer</a><ul id="toc_lst_NBK11643_toc_ch3" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch3_s1"><a class="toc-item" href="/books/n/nicecg80/ch3/#ch3.s1">3.1. Surgery to the Breast</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch3_s9"><a class="toc-item" href="/books/n/nicecg80/ch3/#ch3.s9">3.2. Surgery to the Axilla</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch3_s19"><a class="toc-item" href="/books/n/nicecg80/ch3/#ch3.s19">3.3. Evaluation and Management of a Positive Sentinel Lymph Node</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch3_s22"><a class="toc-item" href="/books/n/nicecg80/ch3/#ch3.s22">3.4. Breast Reconstruction</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch3_rl1"><a class="toc-item" href="/books/n/nicecg80/ch3/#ch3.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch4"><a class="toc-item" href="/books/n/nicecg80/ch4/">4. Postoperative assessment and adjuvant treatment planning</a><ul id="toc_lst_NBK11643_toc_ch4" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch4_s1"><a class="toc-item" href="/books/n/nicecg80/ch4/#ch4.s1">4.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch4_s2"><a class="toc-item" href="/books/n/nicecg80/ch4/#ch4.s2">4.2. Predictive Factors</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch4_s7"><a class="toc-item" href="/books/n/nicecg80/ch4/#ch4.s7">4.3. Adjuvant Treatment Planning</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch4_s10"><a class="toc-item" href="/books/n/nicecg80/ch4/#ch4.s10">4.4. Timing of Adjuvant Treatment</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch4_rl1"><a class="toc-item" href="/books/n/nicecg80/ch4/#ch4.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5"><a class="toc-item" href="/books/n/nicecg80/ch5/">5. Adjuvant systemic therapy</a><ul id="toc_lst_NBK11643_toc_ch5" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5_s1"><a class="toc-item" href="/books/n/nicecg80/ch5/#ch5.s1">5.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5_s2"><a class="toc-item" href="/books/n/nicecg80/ch5/#ch5.s2">5.2. Endocrine Therapy for Invasive Disease</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5_s12"><a class="toc-item" href="/books/n/nicecg80/ch5/#ch5.s12">5.3. Endocrine Therapy for DCIS</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5_s15"><a class="toc-item" href="/books/n/nicecg80/ch5/#ch5.s15">5.4. Chemotherapy</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5_s18"><a class="toc-item" href="/books/n/nicecg80/ch5/#ch5.s18">5.5. Biological Therapy</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5_s30"><a class="toc-item" href="/books/n/nicecg80/ch5/#ch5.s30">5.6. Assessment and Treatment for Bone Loss</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch5_rl1"><a class="toc-item" href="/books/n/nicecg80/ch5/#ch5.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6"><a class="toc-item" href="/books/n/nicecg80/ch6/">6. Adjuvant radiotherapy</a><ul id="toc_lst_NBK11643_toc_ch6" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6_s1"><a class="toc-item" href="/books/n/nicecg80/ch6/#ch6.s1">6.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6_s2"><a class="toc-item" href="/books/n/nicecg80/ch6/#ch6.s2">6.2. Breast Conserving Surgery and Radiotherapy</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6_s9"><a class="toc-item" href="/books/n/nicecg80/ch6/#ch6.s9">6.3. Post-Mastectomy Radiotherapy</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6_s14"><a class="toc-item" href="/books/n/nicecg80/ch6/#ch6.s14">6.4. Dose Fractionation</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6_s17"><a class="toc-item" href="/books/n/nicecg80/ch6/#ch6.s17">6.5. Breast Boost</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6_s20"><a class="toc-item" href="/books/n/nicecg80/ch6/#ch6.s20">6.6. Radiotherapy to Nodal Areas</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch6_rl1"><a class="toc-item" href="/books/n/nicecg80/ch6/#ch6.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch7"><a class="toc-item" href="/books/n/nicecg80/ch7/">7. Primary systemic therapy</a><ul id="toc_lst_NBK11643_toc_ch7" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch7_s1"><a class="toc-item" href="/books/n/nicecg80/ch7/#ch7.s1">7.1. Early Breast Cancer</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch7_s6"><a class="toc-item" href="/books/n/nicecg80/ch7/#ch7.s6">7.2. Locally Advanced or Inflammatory Breast Cancer</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch7_rl1"><a class="toc-item" href="/books/n/nicecg80/ch7/#ch7.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch8"><a class="toc-item" href="/books/n/nicecg80/ch8/">8. Complications of local treatment and menopausal symptoms</a><ul id="toc_lst_NBK11643_toc_ch8" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch8_s1"><a class="toc-item" href="/books/n/nicecg80/ch8/#ch8.s1">8.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch8_s2"><a class="toc-item" href="/books/n/nicecg80/ch8/#ch8.s2">8.2. Complications of Local Treatment</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch8_s9"><a class="toc-item" href="/books/n/nicecg80/ch8/#ch8.s9">8.3. Menopausal Symptoms</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch8_rl1"><a class="toc-item" href="/books/n/nicecg80/ch8/#ch8.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch9"><a class="toc-item" href="/books/n/nicecg80/ch9/">9. Follow-up</a><ul id="toc_lst_NBK11643_toc_ch9" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch9_s1"><a class="toc-item" href="/books/n/nicecg80/ch9/#ch9.s1">9.1. Introduction</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch9_s2"><a class="toc-item" href="/books/n/nicecg80/ch9/#ch9.s2">9.2. Follow-up Imaging</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch9_s11"><a class="toc-item" href="/books/n/nicecg80/ch9/#ch9.s11">9.3. Clinical Follow-up</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_ch9_rl1"><a class="toc-item" href="/books/n/nicecg80/ch9/#ch9.rl1">References</a></li></ul></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appgrp"><a class="toc-item" href="/books/n/nicecg80/appgrp/">Appendices</a><ul id="toc_lst_NBK11643_toc_appgrp" class="simple-list toc bktoc_lst_exp"><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app1"><a class="toc-item" href="/books/n/nicecg80/appendixes.app1/">Appendix 1. Adjuvant! Online: review of evidence concerning its validity, and other considerations relating to its use in the NHS</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app2"><a class="toc-item" href="/books/n/nicecg80/appendixes.app2/">Appendix 2. Algorithms taken from ‘Guidance for the management of breast cancer
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treatment-induced bone loss: A consensus position statement from a UK expert group
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(2008)’</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app3"><a class="toc-item" href="/books/n/nicecg80/appendixes.app3/">Appendix 3. A cost effectiveness analysis of pretreatment ultrasound for the staging of the axilla in early breast cancer patients</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app4"><a class="toc-item" href="/books/n/nicecg80/appendixes.app4/">Appendix 4</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app5"><a class="toc-item" href="/books/n/nicecg80/appendixes.app5/">Appendix 5</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app6"><a class="toc-item" href="/books/n/nicecg80/appendixes.app6/">Appendix 6. Guideline scope</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app7"><a class="toc-item" href="/books/n/nicecg80/appendixes.app7/">Appendix 7. List of topics covered by each chapter</a></li><li class="half_rhythm" id="toc_itm_NBK11643_toc_appendixes_app8"><a class="toc-item" href="/books/n/nicecg80/appendixes.app8/">Appendix 8. People and organisations involved in production of the guideline</a></li></ul></li></ul></div><div><p>This guideline updates and replaces NICE technology appraisal guidance 109 (docetaxel), 108 (paclitaxel) and 107 (trastuzumab).</p></div><div><p>Full Guideline developed for NICE</p><p>Five NICE guidelines have been included on the Bookshelf as part of a pilot
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project. All NICE guidance is available on the NICE website at <a href="http://www.nice.org.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">www<wbr style="display:inline-block"></wbr>.nice.org.uk</a></p></div><div><p>While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical
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literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities
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in the country in which they are practising.</p></div></div></div>
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