Breast Cancer Treatment Guidelines for Patients – Version IX/July 2007

Introduction

With this report, women with breast cancer have access to information on the way breast cancer is treated at the nation’s leading cancer centers. Originally developed for cancer specialists by the National Comprehensive Cancer Network (NCCN), these treatment guidelines have now been translated for the public by the American Cancer Society.

Since 1995, doctors have looked to the NCCN for guidance on the highest quality, most effective advice on treating cancer. For more than 90 years, the public has relied on the American Cancer Society for information about cancer. The Society’s books and brochures provide comprehensive, current, and understandable information to hundreds of thousands of patients, their families, and friends. This collaboration between the NCCN and ACS provides an authoritative and understandable source of cancer treatment information for the public.

These patient guidelines will help you better understand your cancer treatment and your doctor’s counsel. We urge you to discuss them with your doctor. To make the best possible use of this information, you might begin by asking your doctor the following questions:

• How large is my cancer? Do I have more than one tumor in the breast?
• What is my cancer’s grade how abnormal the cells appear) and histology (type and arrangement of tumor cells) as seen under a microscope?
• Do I have any lymph nodes with cancer (positive lymph nodes)? If yes, how many?
• What is the stage of my cancer?
• Does my cancer contain hormone receptors? What does this mean for me?
• Is my cancer positive for HER-2? What does this mean for me?
• Is breast-conserving treatment an option for me?
• In addition to surgery, what other treatment do you recommend? Radiation? Chemotherapy? Hormone therapy?
• What are the side effects?
• Are there any clinical trials that I should consider?

Making Decisions about Breast Cancer Treatment

In the section after the general information about breast cancer, you’ll find flow charts that doctors call decision trees. The charts represent different stages of breast cancer. Each one shows you step-by-step how you and your doctor can arrive at the choices you need to make about your treatment.

Here you will find background information on breast cancer with explanations of cancer stage, work-up, and treatment — all categories used in the flow charts. We’ve also provided a glossary. Words in blue italics are defined in the glossary; you can access their definitions in a small pop-up window by clicking on the word.

Although breast cancer is a very serious disease, it can be treated, and it should be treated by a team of health care professionals with experience in treating women with breast cancer. This team may include a surgeon, radiation oncologist, medical oncologist, radiologist, pathologist, oncology nurse, social worker, and others. But not all women with breast cancer receive the same treatment. Doctors must consider a woman’s specific medical situation and her preferences. This booklet can help you and your doctor decide which choices best meet your medical and personal needs.

Breast cancer can occur in men. Since the incidence is very low, this booklet is for women with breast cancer. To learn more about breast cancer in men, speak with your doctor and contact the American Cancer Society at 1-800-ACS-2345 or www.cancer.org.

Inside Breast Tissue

The main parts of the female breast are lobules (milk-producing glands), ducts(milk passages that connect the lobules and the nipple), and stroma (fatty tissue and ligaments surrounding the ducts and lobules, blood vessels, and lymphatic vessels). Lymphatic vessels are similar to veins but carry lymph instead of blood. Most breast cancer begins in the ducts (ductal), some in the lobules (lobular), and the rest in other breast tissues.

Lymph is a clear fluid that carries tissue waste products and immune system cells. Most lymphatic vessels of the breast lead to underarm (axillary) lymph nodes. Some lead to lymph nodes above the collarbone (called supraclavicular lymph nodes) and others to internal mammary nodes which are next to the breastbone (or sternum). Cancer cells may enter lymph vessels and spread along these vessels to reach lymph nodes. Cancer cells may also enter blood vessels and spread through the bloodstream to other parts of the body.

Lymph nodes are small, bean shaped collections of immune system cells important in fighting infections. When breast cancer cells reach the axillary lymph nodes, they can continue to grow, often causing swelling of the lymph nodes in the armpit or elsewhere.

If breast cancer cells have spread to the axillary lymph nodes, it makes it more likely that they have spread to other organs of the body as well.

The entire report is also available as a PDF file:

NCCN Breast Guidelines.pdf 785 k

You will need Adobe Acrobat to read this file.  Click here to download a current version.

TYPES OF BREAST CANCER

The mutual goal of the National Comprehensive Cancer Network® (NCCN®) and the American Cancer Society (ACS) partnership is to provide patients and the general public with state-of-the-art cancer treatment information in understandable language. This information, based on the NCCN's Clinical Practice Guidelines, is intended to assist you in the dialogue with your physician. These guidelines do not replace the expertise and clinical judgment of your physician. Each patient's situation must be evaluated individually. It is important to discuss the guidelines and all information regarding treatment options with your physician. To ensure that you have the most up-to-date version of the guidelines, consult the web sites of the ACS (www.cancer.org) or NCCN (www.nccn.org). You may also call the NCCN at 1-888-909-NCCN or the ACS at 1-800-ACS-2345 for the most recent information.

NCCN Clinical Practice Guidelines were developed by a diverse panel of experts. The guidelines are a statement of consensus of its authors regarding the scientific evidence and their views of currently accepted approaches to treatment. The NCCN guidelines are updated as new significant data become available. The Patient Information version will be updated accordingly and will be available on-line through the NCCN and the American Cancer Society web sites. To ensure you have the most recent version, you may contact the American Cancer Society or the NCCN.

© 2007 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.