NICE clinical guidelines
Issued: February 2009 (last modified: July 2014)
CG80

Early and locally advanced breast cancer: Diagnosis and treatment

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg80

Introduction

The NICE guideline on advanced breast cancer has been updated. It includes recommendations on exercise for people with or at risk of breast-cancer-related lymphoedema, and these are also relevant for people with early or locally advanced breast cancer. They can be found in the managing complications section of the guideline.

This guideline updates the following technology appraisals:

  • 'Trastuzumab for the adjuvant treatment of early-stage HER2-positive breast cancer' (NICE technology appraisal guidance 107)

  • 'Paclitaxel for the adjuvant treatment of early node-positive breast cancer' (NICE technology appraisal guidance 108)

  • 'Docetaxel for the adjuvant treatment of early node-positive breast cancer' (NICE technology appraisal guidance 109)

NICE and the Department of Health are currently reviewing the future position on updating technology appraisals within clinical guidelines, with particular reference to implications for the funding direction on technology appraisals. In the meantime, the technology appraisal guidance remains available and should continue to be followed. The statutory funding direction remains in place for the recommendations contained in the technology appraisal guidance

Breast cancer is the most common cancer for women in England and Wales, with about 40,500 new cases diagnosed[1],[2] and 10,900 deaths[1],[2] recorded in England and Wales each year. In men breast cancer is rare, with about 260 cases diagnosed[1],[2] and 68 deaths[1],[2] in England and Wales each year. Of these new cases in women and men, a small proportion are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, a considerable number of women who have been previously treated with curative intent subsequently develop either a local recurrence or metastases.

Early breast cancer is subdivided into two major categories, in situ disease, mainly in the form of ductal carcinoma in situ (DCIS), and invasive cancer. Both are heterogeneous processes with very variable appearances, biology and clinical behaviour.

Over recent years there have been important developments in the investigation and management of breast cancer including new types of chemotherapy, and biological and hormonal agents. There is some evidence of practice variation across the country and of inconsistent availability of certain treatments and procedures. This clinical guideline helps to address these issues and offers guidance on best practice.

This guideline assumes that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients.

This guideline recommends some drugs for indications for which they do not have a UK marketing authorisation at the date of publication, as there is good evidence to support that use. Unlicensed drugs are marked with a footnote.



[1] Office for National Statistics (2008) Cancer statistics registrations: registrations of cancer diagnosed in 2005, England. Series MB1 number 36. London: Office for National Statistics.

[2] Welsh Cancer Intelligence and Surveillance Unit (2008) Cancer incidence in Wales. Cardiff: Welsh Cancer Intelligence and Surveillance Unit.