Breast Cancer Treatment Guidelines

  • Robert W. Carlson
  • Stephen B. Edge


The Institute of Medicine has defined clinical practice guidelines as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. Clinical practice guidelines are designed to improve the health outcomes of patients, to facilitate the dissemination of new research results into clinical practice, to minimize variations in care, to minimize the use of ineffective or inadequately effective therapies, and to assure equitable distribution of resources among the existing patient population. A number of such guidelines focusing directly on breast cancer treatment are available that differ in their development process, outcomes of interest, extent of coverage across the disease continuum, frequency of updating, and utility. This chapter provides an overview of commonly used clinical practice guidelines.


Breast Cancer Clinical Practice Guideline National Comprehensive Cancer Network National Comprehensive Cancer Network Guideline Development 
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  1. 1.
    Field MJ, Lohr KN, editors. Clinical practice guidelines: direction for a new program. Washington: National Academy; 1990.Google Scholar
  2. 2.
    Djulbegovic B, Hadley T. Evaluating the quality of clinical guidelines. Linking decisions to medical evidence. Oncology (Williston Park). 1998;12(2010A):310–4.Google Scholar
  3. 3.
    Vincent S, Djulbegovic B. Oncology treatment recommendations can be supported only by 1–2% of high-quality published evidence. Cancer Treat Rev. 2005;31(4):319–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Carlson RW, Hudis CA, Pritchard KI. Adjuvant endocrine therapy in hormone receptor-positive postmenopausal breast cancer: evolution of NCCN, ASCO, and St Gallen recommendations. J Natl Compr Canc Netw. 2006;4(10):971–9.PubMedGoogle Scholar
  5. 5.
    Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA. 2002;287(5):612–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Papanikolaou GN, Baltogianni MS, Contopoulos-Ioannidis DG, Haidich AB, Giannakakis IA, Ioannidis JP. Reporting of conflicts of interest in guidelines of preventive and therapeutic interventions. BMC Med Res Methodol. 2001;1:3.PubMedCrossRefGoogle Scholar
  7. 7.
    Van der Weyden MB. Clinical practice guidelines: time to move the debate from the how to the who. Med J Aust. 2002;176(7):304–5.PubMedGoogle Scholar
  8. 8.
    Collins J. Professionalism and physician interactions with industry. J Am Coll Radiol. 2006;3(5):325–32.PubMedCrossRefGoogle Scholar
  9. 9.
    American Society of Clinical Oncology. Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. J Clin Oncol. 1996;14(2):671–9.Google Scholar
  10. 10.
    Bang SM, Heo DS, Lee KH, Byun JH, Chang HM, Noh DY, et al. Adjuvant doxorubicin and cyclophosphamide versus cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy in premenopausal women with axillary lymph node positive breast carcinoma. Cancer. 2000;89(12):2521–6.PubMedCrossRefGoogle Scholar
  11. 2010.
    Eniu A, Carlson RW, Aziz Z, Bines J, Hortobagyi GN, Bese NS, et al. Breast cancer in limited-resource countries: treatment and allocation of resources. Breast J. 2006;12 suppl 1:S38–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Anderson BO, Shyyan R, Eniu A, Smith RA, Yip C-H, Bese NS, et al. Breast cancer in limited-resource countries: an overview of the breast health global initiative 2005 guidelines. Breast J. 2006;12(s1):S3–15.PubMedCrossRefGoogle Scholar
  13. 13.
    Shyyan R, Masood S, Badwe RA, Errico KM, Liberman L, Ozmen V, et al. Breast cancer in limited-resource countries: diagnosis and pathology. Breast J. 2006;12(s1):S27–37.PubMedCrossRefGoogle Scholar
  14. 14.
    Smith RA, Caleffi M, Albert U-S, Chen THH, Duffy SW, Franceschi D, et al. Breast cancer in limited-resource countries: early detection and access to care. Breast J. 2006;12(s1):S16–26.PubMedCrossRefGoogle Scholar
  15. 15.
    Shekelle PG, Ortiz E, Rhodes S, Morton SC, Eccles MP, Grimshaw JM, et al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA. 2001;286(12):1461–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Cruse H, Winiarek M, Marshburn J, Clark O, Djulbegovic B. Quality and methods of developing practice guidelines. BMC Health Serv Res. 2002;2(1):1.PubMedCrossRefGoogle Scholar
  17. 17.
    Bevers TB, Armstrong DK, Arun B, Carlson RW, Cowan KH, Daly MB, et al. Breast cancer risk reduction. J Natl Compr Canc Netw. 2007;5(8):676–701.PubMedGoogle Scholar
  18. 18.
    Bevers TB, Anderson BO, Bonaccio E, Borgen PI, Buys S, Daly MB, et al. Breast cancer screening and diagnosis. J Natl Compr Canc Netw. 2006;4(5):480–508.PubMedGoogle Scholar
  19. 19.
    Daly MB, Axilbund JE, Bryant E, Buys S, Eng C, Friedman S, et al. Genetic/familial high-risk assessment: breast and ovarian. J Natl Compr Canc Netw. 2006;4(2):156–76.PubMedGoogle Scholar
  20. 20.
    Carlson RW, Anderson BO, Burstein HJ, Carter BW, Edge SB, Farrar WB, et al. The NCCN invasive breast cancer clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2007;5:246–312.PubMedGoogle Scholar
  21. 21.
    Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol. 2007;18(7):201033–44.CrossRefGoogle Scholar
  22. 22.
    Lyman GH, Giuliano AE, Somerfield MR, Benson III AB, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology Guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703–20.PubMedCrossRefGoogle Scholar
  23. 23.
    Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19(5):1539–69.PubMedGoogle Scholar
  24. 24.
    Winer EP, Hudis C, Burstein HJ, Wolff AC, Pritchard KI, Ingle JN, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol. 2005;23(3):619–29.PubMedCrossRefGoogle Scholar
  25. 25.
    Kalaja VV. Recurrent or metastatic breast cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2007;18 suppl 2:ii9–2010.PubMedGoogle Scholar
  26. 26.
    Pestalozzi b. Primary breast cancer: ESMO Clinical recommendations for diagnosis, treatment and follow-up. Annals of Oncology 2007;18(Supplement 2):ii5-ii8.Google Scholar
  27. 27.
    Abdel-Malek N, Chiarelli AM, Sloan M, Stewart DE, Mai V, Howlett RI. Influence of physician and patient characteristics on adherence to breast cancer screening recommendations. Eur J Cancer Prev. 2008;17(1):48–53.PubMedCrossRefGoogle Scholar
  28. 28.
    Palazzi M, De Tomasi D, D’Affronto C, Richetti A, Valli MC, Meregalli S, et al. Are international guidelines for the prescription of adjuvant treatment for early breast cancer followed in clinical practice? Results of a population-based study on 1547 patients. Tumori. 2002;88(6):503–6.PubMedGoogle Scholar
  29. 29.
    White J, Morrow M, Moughan J, Owen J, Pajak T, DesHarnais S, et al. Compliance with breast-conservation standards for patients with early-stage breast carcinoma. Cancer. 2003;97(4):893–904.PubMedCrossRefGoogle Scholar
  30. 30.
    Bloom BS, de Pouvourville N, Chhatre S, Jayadevappa R, Weinberg D. Breast cancer treatment in clinical practice compared to best evidence and practice guidelines. Br J Cancer. 2004;90(1):26–30.PubMedCrossRefGoogle Scholar
  31. 31.
    Hebert-Croteau N, Brisson J, Latreille J, Rivard M, Abdelaziz N, Martin G. Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with node-negative breast cancer. J Clin Oncol. 2004;22(18):3685–93.PubMedCrossRefGoogle Scholar
  32. 32.
    Smith TJ, Hillner BE. Ensuring quality cancer care by the use of clinical practice guidelines and critical pathways. J Clin Oncol. 2001;19(2010):2886–97.PubMedGoogle Scholar
  33. 33.
    Eisinger F, Ronda I, Puig B, Camerlo J, Giovannini MH, Bardou VJ. Breast cancer guidelines–physicians’ intentions and behaviors. Int J Cancer. 2007;120(5):201036–40.Google Scholar
  34. 34.
    Landercasper J, Dietrich LL, Johnson JM. A breast center review of compliance with National Comprehensive Cancer Network Breast Cancer guidelines. Am J Surg. 2006;192(4):525–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer New York 2010

Authors and Affiliations

  1. 1.Division of Oncology, Department of MedicineStanford UniversityStanfordUSA

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