National Comprehensive Cancer Network

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NCCN Updates Breast Cancer Guidelines

Significant new treatments added

JENKINTOWN, Pa., December 13, 2006 — The National Comprehensive Cancer Network (NCCN) is proud to announce several new updates to the NCCN Clinical Practice Guidelines in Oncology™ for Breast Cancer. These changes highlight leading developments in the treatment of breast cancer and represent the recognized standard for clinical policy in oncology in both the community and the academic practice settings.

Based on results from the NSABP Study of Tamoxifen and Raloxifene (STAR) trial, a panel of world-renowned experts added Raloxifene (Evista, Eli Lilly and Company) as an option for reducing the risk of invasive breast cancer in postmenopausal women with lobular carcinoma in situ.

The accuracy of HER2 assays used in clinical practice is a major concern, and results from several studies have shown that false-positive and false-negative HER2 test results are common. An NCCN Task Force reviewed this topic and issued recommendations which are summarized in a section of the guideline entitled “Principles of HER2 Testing.”

When breast MRI is indicated, the panel recommends that it should be performed and interpreted by an expert breast-imaging team working in concert with the multidisciplinary treatment team.

Recent studies document the substantial improvement in outcome with the incorporation of trastuzumab (Herceptin, Genentech) in adjuvant treatment of HER2-postitive breast cancer. The guideline includes specific representative doses and schedules for the recommended adjuvant chemotherapy regimens. A number of chemotherapy regimens have been studied as preoperative chemotherapy. The panel believes that the regimens listed in the adjuvant setting are also appropriate to consider in the neoadjuvant setting.

Aromatase inhibitors are not active in the treatment of women with functioning ovaries and should not be used in women with intact ovarian function. The assessment of ovarian function in women experiencing treatment-induced amenorrhea is difficult and requires re-evaluation over time. This has been elaborated in the “Definition of Menopause” section of the guideline.

NCCN Clinical Practice Guidelines in Oncology™ are developed and updated through a consensus-driven 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 guidelines are available for free at

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 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

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