National Institute for Health and Clinical Excellence (NICE)
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New NICE guidelines on the treatment and care of people with early breast cancer

The National Institute for Health and Clinical Excellence (NICE) yesterday (25 February) issued a new guideline on best practice for the diagnosis and treatment of early and locally advanced breast cancer.

Early breast cancer is diagnosed when the cancer is only found in the breast and the lymph nodes nearby (most often under the arm), and has not spread to other parts of the body. The majority of the 40,500 women and 260 men diagnosed with breast cancer in England and Wales each year have early breast cancer.

Over recent years there have been a number of significant advances in the management of breast cancer including new types of chemotherapy, as well as biological and hormonal agents. The guideline, produced for NICE by the National Collaborating Centre for Cancer, will help clinicians to provide coherent and consistent care for patients with early breast cancer, providing comprehensive information to ensure equal access to services across England and Wales.

Recommendations include:
• Minimal surgery, rather than lymph node clearance, should be performed to stage the axilla for patients with early invasive breast cancer and no evidence of lymph node involvement on ultrasound or a negative ultrasound-guided needle biopsy. Sentinel lymph node biopsy (SLNB) is the preferred technique.
• Discuss immediate breast reconstruction with all patients who are being advised to have a mastectomy, and offer it except where significant comorbidity or (the need for) adjuvant therapy may preclude this option. All
appropriate breast reconstruction options should be offered and discussed with patients, irrespective of whether they are all available locally.
• Patients with early invasive breast cancer should have a baseline dual energy X-ray absorptiometry (DEXA) scan to assess bone mineral density if they:

o are starting adjuvant aromatase inhibitor treatment
o have treatment-induced menopause
o are starting ovarian ablation/suppression therapy.

• Offer annual mammography to all patients with early breast cancer, including DCIS, until they enter the NHS Breast Screening Programme/Breast Test Wales Screening Programme. Patients diagnosed with early breast cancer who are already eligible for screening should have annual mammography for 5 years.
• Patients treated for breast cancer should have an agreed, written care plan, which should be recorded by a named healthcare professional (or professionals), a copy sent to the GP and a personal copy given to the patient.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE said: “These guidelines will raise the standard of care for patients with early breast cancer by providing comprehensive information for GPs, nurses and also for patients themselves. By ensuring breast cancer patients have the information they need, it enables them to make better informed decisions about their care, improving their quality of life during and after treatment.”

Mr James Smallwood, Consultant Surgeon at Southampton University Hospital Trust and Guidance Development Group (GDG) Chair said: “For women breast cancer is still a major fear; over 10,000 women die each year from this disease and many are young. This guidance should help to ensure that all who are diagnosed with this disease receive the same high level of care from appropriately trained professionals who can properly inform them of their choices and support both them and their carers at all times.”

Dr Adrian Harnett, Consultant in Clinical Oncology at Norfolk and Norwich University Hospital NHS Foundation Trust and GDG Lead Clinician said: “With improving survival following treatment of breast cancer, around 80% of patients will be cured of the disease. One focus of this new guideline is that it has refined treatment pathways so that, across the whole country, low risk patients should not
receive unnecessary treatment and patients with more aggressive disease get the best current standard of care. An example of this is better preoperative assessment of the axilla which may result in less invasive surgery and as a consequence less early and late side effects.”

Ursula van Mann, GDG patient representative said: “Facing a cancer diagnosis is frightening and bewildering. Suddenly you are plunged into a world you don’t understand. A breast cancer diagnosis also raises the prospect of disfiguring surgery. Being informed and knowing your options play a key part in managing your disease. Our guideline aims to inform patients of the latest treatments and options and, I’m glad to say, pays attention to their physical and emotional needs as well as their clinical needs.”

Dr Hilary Harris, General Practitioner, Manchester and GDG member said: “The guideline informs both the patient and their primary care provider about investigations, treatment options, and possible side effects. By placing information and choice high on the agenda it empowers patients who are embarking on medical and/or surgical treatments for this disease. Defining follow- up strategies in clear documentation written for the patient and copied to the GP should provide reassurance and allow for a partnership between the patient, primary and secondary care to benefit all patients with a diagnosis of early breast cancer.”

Notes to Editors

About the guideline

1. The early and locally advanced breast cancer guideline is available at: 

About NICE

2. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:
public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

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