Update information

Update information

We have reviewed the evidence and made new recommendations on the diagnosis and treatment of people with early and locally advanced breast cancer. These recommendations are marked [2018].

We have also made some changes without an evidence review:

  • Recommendation 1.2.1 now refers to NICE's guideline on patient experience in adult NHS services because specific communications skills training programmes do not take place any more.

  • In recommendation 1.2.1, the name of the professional has changed to key worker, per the breast cancer quality standard QS12.

  • Recommendation 1.3.3 has been amended because all recurrence rates should be audited, not just for ductal carcinoma in situ (DCIS).

  • Recommendation 1.4.6 was partly updated and replaced; the remaining part on biopsy has been retained.

  • 'Multidisciplinary team' was added to recommendation 1.6.7 to make it clear this is where the results should be discussed.

  • In recommendation 1.1.4, a link has been added to the guideline (CG164) on familial breast cancer, which covers information on genetic testing.

  • Recommendation 1.7.2 was amended because the original recommendations had not made clear that premenopausal women (and men) should receive tamoxifen first line, and that it should be used in low‑risk postmenopausal women as well as if aromatase inhibitors are not tolerated or contraindicated.

  • Recommendation 1.8.4 was amended to distinguish between this recommendation and the new recommendation for T1a/T1b, so it was felt necessary to add 'T1c and above' to this recommendation. The wording of the trastuzumab recommendations have been amended in line with the current summary of product characteristics and the population added to make the recommendation clearer.

  • Recommendation 1.9.4 was reworded to exclude those people who were receiving bisphosphonates as adjuvant therapy.

  • Recommendation 1.10.9 was changed from 'offer' to 'consider' because it contradicted the new recommendations on margins after surgery for DCIS.

  • In recommendation 1.10.7, the word 'adequate' was changed to 'with clear margins'.

  • In recommendation 1.10.14, the term 'site of local excision' has been amended to 'tumour bed', and breast‑conserving surgery has been removed because this is now covered by additional recommendations.

  • In recommendation 1.10.16, the term 'axilla and supraclavicular fossa' has been changed to 'regional lymph nodes'.

  • In recommendation 1.10.17, the term 'ALND' has been changed to 'axillary clearance'.

  • In recommendation 1.12.12, the guideline committee was aware of new evidence on other selective serotonin reuptake inhibitors (SSRIs) and has amended the wording accordingly, but could not be specific because there was no new evidence review in this guideline update.

These recommendations are marked [2009, amended 2018].

Recommendations marked [2009] last had an evidence review in 2009. In some cases, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.

ISBN: 978‑1‑4731‑3008‑1

  • National Institute for Health and Care Excellence (NICE)