Recommendations for research
The 2009 and 2026 guideline committees made the following recommendations for research.
1 Imaging modalities to detect distant metastases in people with lobular breast cancer with suspected metastatic disease
In adults with lobular breast cancer and suspected metastatic disease, what is the diagnostic accuracy and cost effectiveness of different imaging modalities [such as whole-body MRI, fibroblast activation protein inhibitor (FAPI) PET-CT and 18F-fluoroestradiol (FES) PET-CT] for detecting distant metastases? [2026]
Why the committee made this recommendation
The evidence showed that FDG PET-CT had a poor diagnostic accuracy for people with lobular breast cancer. There was no evidence identified for CECT, but the committee agreed that, in their experience, the accuracy is likely to be similar to FDG PET-CT. Because of the limited evidence base and the poor diagnostic accuracy of these types of imaging, the committee made a recommendation for research to address this evidence gap.
Full details of the evidence and the committee's discussion are in evidence review B: FDG PET-CT and contrast-enhanced CT for diagnosing and monitoring distant metastases.
2 Platinums for people with germline BRCA1 or BRCA2/2 pathogenic variants
What is the clinical and cost effectiveness of a platinum-containing chemotherapy regimen compared with a non-platinum-containing chemotherapy regimen in people with advanced breast cancer who have germline BRCA1 or BRCA2 pathogenic variants? [2026]
Why the committee made this recommendation
There was some evidence of very low certainty for the effectiveness of platinum-based chemotherapy for people with advanced breast cancer who have germline BRCA1 or BRCA2 pathogenic variants, and this was limited to people who also had TNBC. As the committee were unable to recommend a different chemotherapy regimen for people who have TNBC with, or without, germline BRCA1 or BRCA2 pathogenic variants because of the limited number of included trials and small number of participants in them, they drafted a recommendation for research to try to address the lack of evidence in this area.
Full details of the evidence and the committee's discussion are in evidence review A: platinum-containing chemotherapy regimens.
3 Uncontrolled local disease
The relevant research organisations should be encouraged to address the topic of uncontrolled local disease and devise appropriate research studies. This might include development of a national register.
For example, what are the best methods of controlling local disease in people with stable advanced breast cancer who have progressive recurrent local disease? [2009, amended 2026]
Why this is important
The problem of how best to manage uncontrolled local disease is very poorly addressed by the current evidence. Although it is probably quite an uncommon condition, it is likely that across the country there are enough people to generate evidence from well-coordinated national studies. A national register should be considered as part of this because of the current uncertainties about the frequency of the problem.
Understanding effectiveness of different interventions and the underlying biology of local recurrence could lead to better local treatments in both the primary and secondary setting. [2009, amended 2026]