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NCCN Updates Breast Cancer and Breast Cancer Risk Reduction Guidelines


NCCN announces new updates to the NCCN Guidelines for Breast Cancer and Breast Cancer Risk Reduction Guidelines. Noteworthy additions include new recommendations on when to use MRIs in breast cancer evaluations, statements discouraging the use of PET/CT scanning for evaluative purposes, and new cosmetic recommendations for women undergoing reconstructive surgery.


February 3, 2009

FORT WASHINGTON, PA — The National Comprehensive Cancer Network (NCCN) announces important updates to the NCCN Clinical Practice Guidelines in Oncology™ for Breast Cancer and Breast Cancer Risk Reduction. These changes reflect leading developments in the treatment of patients with breast cancer and represent the standard of clinical policy in oncology in both community and academic settings.

Notable diagnostic additions to the NCCN Guidelines include a recommendation for genetic counseling if the patient is high risk for hereditary breast cancer, as well as six new recommendations detailing when MRIs may be helpful in breast cancer evaluations.

Conversely, the updated NCCN Guidelines for Breast Cancer state that PET/CT scanning is not recommended for evaluation of newly diagnosed patients with early stage disease except in those clinical situations where other staging studies are equivocal or suspicious, and even in these situations that biopsy is recommended. The NCCN Guideline Panel Members for Breast Cancer note that although there is limited evidence demonstrating the utility of PET/CT scan in the staging of patients, they consider biopsy to be more likely to provide useful staging information.

The updated NCCN Guidelines continue to recognize bisphosphonates as the preferred intervention to treat osteoporosis in women with breast cancer, while the use of estrogen, progesterone, or selective estrogen receptor modulators is discouraged.

Significant additions were also made to the portion of the NCCN Guidelines providing recommendations for patients undergoing breast reconstruction following surgery. It is now recommended that women receive an evaluation detailing the likely cosmetic outcome of a lumpectomy prior to the actual surgery. Furthermore, women who are not satisfied with the cosmetic outcome following completion of breast cancer treatment should be offered a plastic surgery consultation.

Notable additions to the NCCN Guidelines for Breast Cancer Risk Reduction include updates to two risk-reduction agents, tamoxifen (Soltamox™, AstraZeneca) and raloxifine (Evista®, Eli Lilly and Company).Tamoxifen is recommended for premenopausal women with a history of atypical hyperplasia to reduce breast cancer risk. For postmenopausal women, raloxifene is listed as equivalent to tamoxifen in reducing the risk of developing invasive breast cancer; however, it did not provide the same level of risk reduction for developing non-invasive breast cancer.

Breast cancer remains the second leading cause of cancer death after lung cancer in women in the United States. It is estimated that more than 180,000 new cases of breast cancer will be diagnosed in women in 2009.

NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through an evidence-based process with explicit review of the scientific evidence by multidisciplinary panels of expert physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at www.nccn.org.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 25 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.

The NCCN Member Institutions are:

  • Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center
  • City of Hope Comprehensive Cancer Center
  • Dana-Farber/Brigham and Women's Cancer Center
    Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Cancer Institute
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Comprehensive Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital