The NCCN Breast Cancer Clinical Practice Guidelines in Oncology TM Robert W. Carlson, MD; D. Craig Allred, MD; Benjamin O. Anderson, MD; Harold J. Burstein, MD, PhD; W. Bradford Carter, MD; Stephen B. Edge, MD; John K. Erban, MD; William B. Farrar, MD; Lori J. Goldstein, MD; William J. Gradishar, MD; Daniel F. Hayes, MD; Clifford A. Hudis, MD; Mohammad Jahanzeb, MD; Krystyna Kiel, MD; Britt-Marie Ljung, MD; P. Kelly Marcom, MD; Ingrid A. Mayer, MD; Beryl McCormick, MD; Breast Cancer Clinical Practice Guidelines in Oncology Key Words NCCN Clinical Practice Guidelines, breast cancer, chemotherapy, breast-conserving therapy, adjuvant therapy, mastectomy, en- docrine therapy, radiation, therapy, lobular carcinoma in situ, ductal carcinoma in situ (JNCCN 2009;7:122–192) NCCN Categories of Evidence and Consensus Category 1: The recommendation is based on high-level ev- idence (e.g., randomized controlled trials) and there is uni- form NCCN consensus. Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. The Breast Cancer Clinical Practice Guidelines presented here are the work of the members of the NCCN Breast Cancer Clinical Practice Guidelines Panel. Categories of evidence were assessed and are noted on the algorithms and in the text. Although not explicitly stated at every decision point of the Guidelines, patient participation in prospective clinical trials is the preferred option of treatment for all stages of breast can- cer. The full breast cancer guidelines are not printed in this is- sue of JNCCN, but can be accessed online at www.nccn.org. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please Note These guidelines are a statement of consensus of the au- thors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network makes no representation or warranties of any kind regarding their content, use, or ap- plication and disclaims any responsibility for their appli- cations or use in any way. These guidelines are copyrighted by the National Comprehensive Cancer Network. All rights reserved. These guidelines and the illustrations herein may not be repro- duced in any form without the express written permission of the NCCN © 2009. Disclosures for the NCCN Breast Cancer Guidelines Panel At the beginning of each NCCN guidelines panel meeting, panel members disclosed any financial support they have received from industry. Through 2008, this information was published in an aggregate statement in JNCCN and online. Furthering NCCN’s commitment to public transparency, this disclosure process has now been expanded by listing all potential conflicts of interest respective to each individual expert panel member. Individual disclosures for the NCCN Breast Cancer Guidelines Panel members can be found on page 192. (To view the most re- cent version of these guidelines and accompanying disclosures, visit the NCCN Web site at www.nccn.org.) These guidelines are also available on the Internet. For the latest update, please visit www.nccn.org. 122 Lisle M. Nabell, MD; Lori J. Pierce, MD; Elizabeth C. Reed, MD; Mary Lou Smith, JD, MBA; George Somlo, MD; Richard L. Theriault, DO, MBA; Neal S. Topham, MD; John H. Ward, MD; Eric P. Winer, MD; and Antonio C. Wolff, MD Overview The American Cancer Society estimated that 184,450 new cases of invasive breast cancer would be diag- nosed and 40,930 patients would die of the disease in the United States in 2008. 1 In addition, approximately 67,770 women will be diagnosed with carcinoma in situ of the breast during the same year. Breast cancer is the © Journal of the National Comprehensive Cancer Network Volume 7 Number 2 February 2009 . All rights reserved. Copyright © 2009 by the National Comprehensive Cancer Network from 67.183.158.11 on May 5, 2014 by BENJAMIN ANDERSON jnccn.org Downloaded from