The National Comprehensive Cancer Network (NCCN) is a network of cancer professionals who develop voluntary guidelines for screening, prevention and treatment of cancer.  They recently updated their guidelines for breast cancer to reflect new developments in breast cancer screening and treatment.

 

"Based on results from the NSABP Study of Tamoxifen and Raloxifene (STAR) trial, a panel of world-renowned experts added Raloxifene (Evista, Eli Lilly and Company) as an option for reducing the risk of invasive breast cancer in postmenopausal women with lobular carcinoma in situ.

The accuracy of HER2 assays used in clinical practice is a major concern, and results from several studies have shown that false-positive and false-negative HER2 test results are common. An NCCN Task Force reviewed this topic and issued recommendations which are summarized in a section of the guideline entitled "Principles of HER2 Testing."

When breast MRI is indicated, the panel recommends that it should be performed and interpreted by an expert breast-imaging team working in concert with the multidisciplinary treatment team.

Recent studies document the substantial improvement in outcome with the incorporation of trastuzumab (Herceptin, Genentech) in adjuvant treatment of HER2-postitive breast cancer. The guideline includes specific representative doses and schedules for the recommended adjuvant chemotherapy regimens. A number of chemotherapy regimens have been studied as preoperative chemotherapy. The panel believes that the regimens listed in the adjuvant setting are also appropriate to consider in the neoadjuvant setting.

Aromatase inhibitors are not active in the treatment of women with functioning ovaries and should not be used in women with intact ovarian function. The assessment of ovarian function in women experiencing treatment-induced amenorrhea is difficult and requires re-evaluation over time. This has been elaborated in the "Definition of Menopause" section of the guideline.

NCCN Clinical Practice Guidelines in Oncology(TM) are developed and updated through a consensus-driven process with explicit review of the scientific evidence by multidisciplinary panels of expert physicians from NCCN member institutions. The most recent version of this and all the guidelines are available for free at www.nccn.org."