Summary of recommendations and practice points

This page provides a list of the recommendations and practice points contained with the Guidance for the management of early breast cancer (2020). Comprehensive, up-to-date guidance is provided for the management and care of early breast cancer from the point of diagnosis forwards. This guidance has been developed using a meta-guideline process, as described in the Methods report. 

The recommendations and practice points are a guide to appropriate practice, to be followed subject to the clinician’s judgement and the person’s preferences in each individual case.  Implementation of this guidance should be informed by the underlying key principles of care.

More information about each recommendation or practice point, including the background behind its development and links to useful resources, can be found by visiting the webpage for that guidance point.

Treatment planning, information and support

Multidisciplinary care and Care coordination

Patient information and support

Assessment and referral

Complementary and alternative therapies

Pathology and imaging prior to treatment

Treatment

Research and clinical trials

Neoadjuvant therapy

Surgery

Surgery timing

Breast-conserving surgery (BCS) and mastectomy

Breast reconstruction

Sentinel node biopsy (SNB) and axilla management

Risk-reducing strategies

  • Recommendation

    In patients with breast cancer with a population risk of contralateral breast cancer (that is, no genetic predisposition) do not routinely offer risk-reducing mastectomy for the contralateral breast.

    09 October 2020
  • Recommendation

    In premenopausal women with breast cancer with a confirmed germline mutation (e.g. BRCA 1/2) that predisposes to an increased risk of breast cancer, discuss risk-reducing strategies (e.g. contralateral risk-reducing mastectomy or endocrine therapy/ risk-reducing medication).

    09 October 2020
  • Recommendation

    In women with breast cancer with a confirmed germline mutation (e.g. BRCA 1/2) that predisposes to an increased risk of ovarian/fallopian tube cancer, refer to a gynaecological oncologist for discussion of the benefits and risks of bilateral salpingo-oophorectomy (BSO).

    09 October 2020

Systemic therapy

Systemic therapy planning

Chemotherapy

Anti-HER2 therapy

Cardiac dysfunction during treatment

  • Recommendation

    Consider routine surveillance, preferably with an echocardiogram, of asymptomatic patients considered to be at increased risk of developing cardiac dysfunction. Frequency of surveillance should be determined by patient baseline and future risk of cardiotoxicity.

    Updated: 07 April 2021
  • Recommendation

    In patients with clinical signs or symptoms of cardiac dysfunction during routine clinical assessment throughout treatment, the following approaches are recommended:
    i. Echocardiogram for diagnostic workup
    ii. Cardiac MRI can be performed if echocardiogram is not available or is not technically feasible (e.g. poor image quality). Alternatively, gated heart pool scan can be considered
    iii. Serum cardiac biomarkers (troponins, natriuretic peptides) as an adjunct to imaging and clinical assessment
    iv. Refer to a cardiologist based on clinical context and findings.

    Consider deferral or cessation of cardiotoxic treatment where clinically indicated, in collaboration with a cardiologist.

    12 October 2020

Endocrine therapy

Bone-modifying agents and bone health

Radiation therapy

Radiation therapy timing

Radiation therapy after neoadjuvant chemotherapy

Radiation therapy after breast-conserving surgery

Radiation therapy after mastectomy

Radiation therapy of nodal regions

Radiation therapy and adverse events

Follow-up and survivorship

Continuity of care and patient information

Follow-up care providers and plan

Patient information

Surveillance & imaging

Follow-up surveillance

Follow-up imaging

Management of long-term and late effects

Lymphoedema management

Menopausal symptoms

Reproductive and sexual health

Fatigue and sleep disorders

Pain

Cognitive impairment

Psychosocial needs

  • Practice Point

    Diagnose and treat anxiety and depression in patients with breast cancer the same way as in the general population, noting that anxiety and depression reduce an individual’s ability to cope with disease and treatment burden. Be aware that menopausal symptoms and anxiety and depression are interconnected: treatment of menopausal symptoms may improve anxiety and depression (particularly via the resolution of sleep disturbance), while treatment of anxiety and depression may improve an individual’s ability to cope with menopausal symptoms.

    13 October 2020
  • Practice Point

    Ask patients if they are worried about the cancer recurring. Assess whether these worries are having a significant impact on their life and if so, offer referral to a psychologist.

     

    13 October 2020
  • Practice Point

    Be aware that returning to work or caring duties after breast cancer treatment is often a challenge and that extra professional support may be needed (e.g. psychological services). 

    13 October 2020
  • Practice Point

    For patients contemplating returning to work, consider referral for vocational rehabilitation programs where available

    Updated: 07 April 2021