Table of contents
Breast cancer
What's new
The American Society of Clinical Oncology (ASCO) has updated its guideline on sentinel lymph node biopsy (SLNB) in early-stage breast cancer. SLNB is suggested for patients with operable disease in any of the following situations: multicentric tumors with clinically node-negative status, male breast cancer, pregnancy, obesity, clinical tumor size between ≥3 cm and <5 cm without nodal involvement, ductal carcinoma in situ undergoing mastectomy, or prior breast or axillary surgery. SLNB may be omitted in selected patients with small (≤2 cm) breast cancer and negative preoperative axillary lymph node ultrasound findings if all of the following criteria are met: postmenopausal and aged ≥50 years, unifocal invasive ductal carcinoma ≤2 cm, Nottingham grade 1 or 2, HR+ HER2- in patients planning adjuvant endocrine therapy, no suspicious lymph nodes on axillary ultrasound or only one suspicious node with benign biopsy concordant with ultrasound findings, and planned upfront breast-conserving surgery followed by whole-breast radiotherapy in patients aged <65 years. .
Background
Overview
Guidelines
Key sources
Screening and diagnosis
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Indications for screening (high-risk females)
Diagnostic investigations
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Breast imaging
Imaging for staging (early breast cancer)
Imaging for staging (metastatic breast cancer)
Laboratory tests
Assessment of fracture risk
Diagnostic procedures
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Biomarker testing, early breast cancer (general principles)
Biomarker testing, early breast cancer (Oncotype DX)
Biomarker testing, early breast cancer (MammaPrint)
Biomarker testing, early breast cancer (EndoPredict)
Biomarker testing, early breast cancer (Prosigna)
Biomarker testing, early breast cancer (Ki67)
Biomarker testing, early breast cancer (IHC4)
Biomarker testing, early breast cancer (BCI)
Biomarker testing, early breast cancer (CTS5)
Biomarker testing, early breast cancer (tumor infiltrating lymphocytes)
Biomarker testing, early breast cancer (PD-L1)
Biomarker testing, early breast cancer (circulating tumor cells)
Biomarker testing, early breast cancer (ctDNA)
Biomarker testing, metastatic breast cancer (NTRK fusion)
Biomarker testing, metastatic breast cancer (PD-L1)
Biomarker testing, metastatic breast cancer (dMMR/MSI-H)
Biomarker testing, metastatic breast cancer (tumor mutational burden)
Biomarker testing, metastatic breast cancer (TROP2)
Biomarker testing, metastatic breast cancer (homologous recombination deficiency)
Biomarker testing, metastatic breast cancer (circulating tumor cells)
Biomarker testing, metastatic breast cancer (ctDNA)
Genetic testing (BRCA1/2)
Genetic testing (ESR1)
Genetic testing (PIK3CA)
Genetic testing (PALB2)
Genetic testing (other genes)
Medical management
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Management of DCIS (breast-conserving surgery)
Management of DCIS (whole-breast irradiation)
Management of DCIS (partial-breast irradiation)
Management of DCIS (adjuvant endocrine therapy)
Management of early breast cancer (neoadjuvant therapy, general principles)
Management of early breast cancer (neoadjuvant therapy, HR+ HER2-)
Management of early breast cancer (neoadjuvant therapy, HER2+)
Management of early breast cancer (neoadjuvant therapy, triple-negative)
Management of early breast cancer (neoadjuvant therapy, monitoring)
Management of early breast cancer (breast-conserving surgery)
Management of early breast cancer (mastectomy)
Management of early breast cancer (sentinel lymph node biopsy)
Management of early breast cancer (axillary lymph node dissection)
Management of early breast cancer (locoregional lymph node irradiation)
Management of early breast cancer (ultrasound-guided staging)
Management of early breast cancer (adjuvant radiotherapy, after breast-conserving surgery)
Management of early breast cancer (adjuvant radiotherapy, after mastectomy)
Management of early breast cancer (adjuvant endocrine therapy, HR+ HER2-)
Management of early breast cancer (adjuvant CDK and PARP inhibitors, HR+ HER2-)
Management of early breast cancer (adjuvant chemotherapy, HR+ HER2-)
Management of early breast cancer (adjuvant chemotherapy, HR+, HER2-)
Management of early breast cancer (adjuvant systemic therapy, HER2+)
Management of early breast cancer (adjuvant systemic therapy, triple-negative)
Management of early breast cancer (ovarian suppression)
Management of early breast cancer (bone-modifying agents)
Management of metastatic breast cancer (systemic therapy, general principles, HR+ HER2-)
Management of metastatic breast cancer (systemic therapy, first-line, HR+ HER2-)
Management of metastatic breast cancer (systemic therapy, second-line, HR+ HER2-)
Management of metastatic breast cancer (systemic therapy, third-line, HR+ HER2-)
Management of metastatic breast cancer (systemic therapy, first-line, HER2+)
Management of metastatic breast cancer (systemic therapy, second-line, HER2+)
Management of metastatic breast cancer (systemic therapy, third-line, HER2+)
Management of metastatic breast cancer (systemic therapy, triple-negative)
Management of metastatic breast cancer (ovarian suppression)
Management of metastatic breast cancer (bone-modifying agents)
Management of metastatic breast cancer (local management)
Management of metastatic breast cancer (management of bone metastases)
Management of metastatic breast cancer (management of brain metastases)
Nonpharmacologic interventions
Specific circumstances
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Elderly patients
Male patients (genetic testing)
Male patients (management of early breast cancer)
Male patients (management of metastatic breast cancer)
Male patients (surveillance)
Patient education
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Reproductive counseling
Preventative measures
Follow-up and surveillance
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Assessment of treatment response
Surveillance for metastases
Surveillance for recurrence (general principles)
Surveillance for recurrence (early breast cancer)
Surveillance for other malignancies
Long-term survivorship