This guideline covers diagnosing and managing early and locally advanced breast cancer. It aims to help healthcare professionals offer the right treatments to people, taking into account the person's individual preferences.
For information on related topics, see our breast cancer summary page and our guideline on suspected cancer: recognition and referral. NICE has also produced guidelines on advanced breast cancer and familial breast cancer.
In January 2024, we reviewed the evidence and updated the recommendations on further surgery after breast-conserving surgery. We also updated some recommendations for style and consistency, or to reflect current practice. For more details, see the update information.
This guideline includes recommendations on:
- referral, diagnosis and preoperative assessment
- information and support
- surgery and breast reconstruction
- diagnostic assessment and adjuvant therapy planning
- endocrine therapy, adjuvant chemotherapy, bisphosphonate therapy and radiotherapy
- primary systemic therapy
- managing complications of local treatment (lymphoedema, and arm and shoulder mobility) and menopausal symptoms
- follow-up and lifestyle advice
Who is it for?
- Healthcare professionals
- Commissioners and providers of breast cancer services
- People with early and locally advanced breast cancer, their families and carers
Is this guideline up to date?
- January 2023: We have checked the guideline and identified several areas for update. For details, see the January 2023 surveillance decision.
Updates in progress:
- Neoadjuvant chemotherapy: see the January 2023 surveillance decision and the guideline update page.
- Lymphoedema prevention and management: see the January 2023 surveillance decision and the guideline update page.
Areas that will not be updated:
- Bisphosphonate therapy: see the August 2022 surveillance decision.
Guideline development process
This guideline updates and replaces NICE guideline CG80 (February 2009), NICE technology appraisal guidance 107, 108, 109 and 112 (published 2006) and NICE evidence summary ES15.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.