NCCN Clinical Practice Guidelines in Oncology (NCCN ...

1 Version , 07/15/20 2020 National Comprehensive cancer Network ( nccn ), All rights reserved. nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of Clinical Practice Guidelines in Oncology ( nccn Guidelines ) breast CancerVersion July 15, Guidelines for Patients available at Guidelines Version CancerVersion , 07/15/20 2020 National Comprehensive cancer Network ( nccn ), All rights reserved. nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of Guidelines IndexTable of ContentsDiscussion*William J.

2 Gradishar, MD/Chair Robert H. Lurie Comprehensive cancer Center of Northwestern University*Benjamin O. Anderson, MD/Vice-Chair Fred Hutchinson cancer Research Center/Seattle cancer Care AllianceJame Abraham, MD Case Comprehensive cancer Center/ University Hospitals Seidman cancer Center and Cleveland Clinic Taussig cancer InstituteRebecca Aft, MD, PhD Siteman cancer Center at Barnes- Jewish Hospital and Washington University School of MedicineDoreen Agnese, MD The Ohio State University Comprehensive cancer Center - James cancer Hospital and Solove Research Institute Kimberly H.

3 Allison, MD Stanford cancer InstituteSarah L. Blair, MD UC San Diego Moores cancer CenterHarold J. Burstein, MD, PhD Dana-Farber/Brigham and Women s cancer CenterChau Dang, MD Memorial Sloan Kettering cancer CenterAnthony D. Elias, MD University of Colorado cancer CenterSharon H. Giordano, MD, MPH The University of Texas MD Anderson cancer CenterMatthew P. Goetz, MD Mayo Clinic cancer CenterLori J. Goldstein, MD Fox Chase cancer CenterSteven J. Isakoff, MD, PhD Massachusetts General Hospital cancer CenterJairam Krishnamurthy, MD Fred & Pamela Buffet cancer CenterJanice Lyons, MD Case Comprehensive cancer Center/ University Hospitals Seidman cancer Center and Cleveland Clinic Taussig cancer InstituteP.

4 Kelly Marcom, MD Duke cancer InstituteJennifer Matro, MD Abramson cancer Center at the University of PennsylvaniaIngrid A. Mayer, MD Vanderbilt-Ingram cancer CenterMeena S. Moran, MD Yale cancer Center/Smilow cancer HospitalJoanne Mortimer, MD City of Hope National Medical CenterRuth M. O'Regan, MD University of Wisconsin Carbone cancer CenterSameer A. Patel, MD Fox Chase cancer CenterLori J. Pierce, MD University of Michigan Rogel cancer CenterHope S. Rugo, MD UCSF Helen Diller Family Comprehensive cancer CenterAmy Sitapati, MD UC San Diego Moores cancer CenterKaren Lisa Smith, MD, MPH The Sidney Kimmel Comprehensive cancer Center at Johns HopkinsMary Lou Smith, JD, MBA Research Advocacy NetworkHatem Soliman, MD Moffitt cancer CenterErica M.

5 Stringer-Reasor, MD O'Neal Comprehensive cancer Center at UABM elinda L. Telli, MD Stanford cancer InstituteJohn H. Ward, MD Huntsman cancer Institute at the University of UtahJessica S. Young, MD Roswell Park Comprehensive cancer CenterNCCNR ashmi Kumar, PhDJennifer BurnsNCCN Guidelines Panel DisclosuresContinue Hematology/Hematology Oncology Internal medicine Medical Oncology Pathology Patient advocacy Radiation Oncology /Radiotherapy Reconstructive surgery Surgery/Surgical Oncology * Discussion Section Writing CommitteeNCCN Guidelines Version CancerVersion , 07/15/20 2020 National Comprehensive cancer Network ( nccn ), All rights reserved.

6 nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of Guidelines IndexTable of ContentsDiscussionClinical Trials: nccn believes that the best management for any patient with cancer is in a Clinical trial. Participation in Clinical trials is especially encouraged. To find Clinical trials online at nccn Member Institutions, click Categories of Evidence and Consensus: All recommendations are category 2A unless otherwise indicated. See nccn Categories of Evidence and Categories of Preference: All recommendations are considered nccn Categories of breast cancer Panel MembersSummary of Guidelines UpdatesRecommendations for Lobular Carcinoma In Situ were removed from the nccn Guidelines for breast cancer , See nccn Guidelines for breast Screening and DiagnosisNoninvasive breast cancer :D uctal Carcinoma In Situ (DCIS) Workup and Primary Treatment (DCIS-1)DCIS Postsurgical Treatment and Surveillance/Follow-up (DCIS-2)Invasive breast cancer .

7 Clinical Stage, Workup (BINV-1)Locoregional Treatment of T1 3,N0 1,M0 Disease (BINV-2)Systemic Adjuvant Treatment Hormone Receptor-Positive HER2-Positive Disease (BINV-5) N ode-Negative Hormone Receptor-Positive HER2-Negative Disease (BINV-6) N ode-Positive Hormone Receptor-Positive HER2-Negative Disease (BINV-7) Hormone Receptor-Negative HER2-Positive Disease (BINV-8) Hormone Receptor-Negative HER2-Negative Disease (BINV-9) Favorable Histologies (BINV-10)Workup Prior to Preoperative Systemic Therapy (BINV-11)A djuvant Systemic Therapy After Preoperative Systemic Therapy (BINV-15)Surveillance/Follow-Up (BINV-16)Recurrent/Stage IV (M1) Disease (BINV-17)Treatment of Local and Regional Recurrence (BINV-18)Systemic Treatment of Recurrent or Stage IV (M1) Disease (BINV-19)The nccn Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment.

8 Any clinician seeking to apply or consult the nccn Guidelines is expected to use independent medical judgment in the context of individual Clinical circumstances to determine any patient s care or treatment. The National Comprehensive cancer Network ( nccn ) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The nccn Guidelines are copyrighted by National Comprehensive cancer Network . All rights reserved. The nccn Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of nccn .

9 Of Biomarker Testing (BINV-A)Principles of Dedicated breast MRI Testing (BINV-B)Fertility and Birth Control (BINV-C)Surgical Axillary Staging (BINV-D)Axillary Lymph Node Staging (BINV-E)M argin Status Recommendations for DCIS and Invasive breast cancer (BINV-F)Special Considerations to breast -Conserving Therapy Requiring RT (BINV-G)P rinciples of breast Reconstruction Following Surgery (BINV-H) Principles of Radiation Therapy (BINV-I)Special Considerations for breast cancer in Men (BINV-J)Adjuvant Endocrine Therapy (BINV-K)Preoperative/Adjuvant Therapy Regimens (BINV-L)Principles of Preoperative Systemic Therapy (BINV-M)G ene Expression Assays for Consideration of Addition of Adjuvant Systemic Chemotherapy to Adjuvant Endocrine Therapy (BINV-N)Definition of Menopause (BINV-O)S ystemic Therapy for ER- and/or PR-Positive Recurrent or Stage IV (M1) Disease (BINV-P)S ystemic Therapy Regimens for Recurrent or Stage IV (M1) Disease (BINV-Q)A dditional Targeted Therapies and Associated Biomarker Testing for Recurrent or Stage IV (M1) Disease (BINV-R)

10 Principles of Monitoring Metastatic Disease (BINV-S)Special Considerations:Phyllodes Tumor (PHYLL-1)Paget s Disease (PAGET-1) breast cancer During Pregnancy (PREG-1)Inflammatory breast cancer (IBC-1)Staging (ST-1) nccn Guidelines Version CancerVersion , 07/15/20 2020 National Comprehensive cancer Network ( nccn ), All rights reserved. nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of Guidelines IndexTable of ContentsDiscussionContinuedUPDATESU pdates in Version of the nccn Guidelines for breast cancer from Version include:BINV-L & BINV-Q Preoperative/adjuvant therapy for HER2-positive disease and sytemic therapy for HER2-positive recurrent or stage IV (M1) disease: Footnote added.