National Comprehensive Cancer Network



About NCCN

Looking Back on Two Decades of Breast Cancer Treatment: Targeted Therapy and Improved Surgical Procedures are Key Enhancements

NCCN has published the 20th annual edition of the NCCN Guidelines® for Breast Cancer, one of the original NCCN Guidelines published in November 1996.

FORT WASHINGTON, PA — Breast cancer is the most frequently diagnosed cancer globally and the leading cause of cancer-related death in women. However, the incidence of breast cancer has somewhat stabilized over the past few decades, and breast cancer mortality appears to be declining[1], suggesting a benefit from the combination of early detection and more effective treatment.[2]

The National Comprehensive Cancer Network® (NCCN®) has published the 20th annual edition of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer—one of the original NCCN Guidelines® published in November 1996.

“It is fascinating to look back at the original NCCN Guidelines for Breast Cancer—so many things have changed,” said William J. Gradishar, MD, Professor in Medicine – Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and Chair of the NCCN Guidelines Panel for Breast Cancer. “An incredible amount of progress has been made in surgical procedures and treatment based on tumor characteristics.”

From a surgical standpoint, said Dr. Gradishar, axillary lymph node dissection was the standard of care in 1996. Today, the less invasive sentinel lymph node (SLN) biopsy is the standard of care for patients with early-stage breast cancer to determine spread of the disease, which has removed the risk of unnecessary extensive lymph node removal, as well as decreased the risks of post-surgical complications.[3]

“How we thought about adjuvant therapy has changed,” said Dr. Gradishar. “Physicians used to look at the number of nodes as a determinant of whether a patient was a candidate for chemotherapy, as well as what kind of chemotherapy was appropriate. Now we use genomic profiling to influence our decision-making. Additionally, the chemotherapy regimens have changed and endocrine therapy options have expanded, as has the duration of therapy.”

Indeed, genomic testing and targeted therapies have changed the course of breast cancer treatment. In particular, according to Dr. Gradishar, 20 years ago human epidermal growth factor receptor (HER2)-positive disease was not listed in the guidelines, and today the NCCN Guidelines recommendations include a cadre of successful neoadjuvant and adjuvant chemotherapies for people with HER2-positive disease.

 “As the founding chair of the NCCN Guidelines Panel for Breast Cancer, I am especially pleased to announce the 20th annual edition of the NCCN Guidelines for Breast Cancer,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN, and Former Chair of the NCCN Guidelines Panel for Breast Cancer. “Over the past two decades, the global focus on breast cancer has grown exponentially and with the expertise and experience of the NCCN Guidelines panel, oncologists around the world have consistently had access to high-quality, high-value treatment recommendations.”

In addition to the NCCN Guidelines for Breast Cancer, NCCN also offers the following resources for clinicians and patients: NCCN Guidelines for Breast Cancer Risk Reduction, NCCN Guidelines for Breast Cancer Screening and Diagnosis, NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast and Ovarian, and NCCN Guidelines for Patients®: Breast Cancer (Stages 0 – IV).

Today, NCCN develops and maintains 60 NCCN Guidelines, covering 97% of malignant cancers affecting people in the United States. The NCCN Guidelines are developed and updated through an evidence-based process in which the expert panels integrate comprehensive clinical and scientific data with the judgment of the multidisciplinary panel members and other experts drawn from NCCN Member Institutions. Access to the complete library of NCCN Guidelines is available free-of-charge at NCCN.org.

In January, NCCN celebrated its 20th anniversary and on March 12 – 14, 2015, NCCN will host its 20th Annual Conference: Advancing the Standard of Cancer Care™ at The Diplomat in Hollywood, Florida. In recognition of its 20th anniversary, NCCN will host a special live roundtable during the conference featuring NCCN leadership—past and present—as well as other stakeholders who have had a significant impact on the development, progressions, and success of NCCN over the years. Noteworthy historical NCCN accomplishment and events will be discussed, as well as the impact NCCN has had and continues to have on the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. 

To learn more about NCCN, the NCCN Guidelines, and the NCCN 20th Annual Conference, visit NCCN.org.

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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 devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. 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 NCCN Member Institutions are: Fred and Pamela Buffett Cancer Center; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients.


[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.

[2] The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer (Version 1.2015). © 2015 National Comprehensive Cancer Network, Inc. Available at: NCCN.org. Accessed February 10, 2015. To view the most recent and complete version of the NCCN Guidelines®, go online to NCCN.org.

[3] "Sentinel Lymph Node Biopsy." National Cancer Institute. Web. Accessed 10 Feb. 2015. <http://www.cancer.gov/cancertopics/factsheet/detection/sentinel-node-biopsy>.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 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
  • Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
  • 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
  • University of Wisconsin Carbone Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital