Understanding Breast Cancer Standard of Care

What is the gold standard for breast cancer treatment? How do the breast cancer treatments approved by the National Comprehensive Cancer Network (NCCN) guide physicians and their patients? What are the differences between urban and rural communities when it comes to breast cancer standard of care?

It's important to note that the below guidelines are intended to be used as a reference and should be tailored to each individual person's needs and risk factors. Healthcare providers should discuss screening and prevention options with their patients to make informed decisions together.

In this blog we are going to address some of these burning questions.

What are the NCCN Guidelines?

The National Comprehensive Cancer Network (NCCN) Guidelines are evidence-based treatment recommendations for breast cancer that provide the most up-to-date information and best practices for the diagnosis and management of cancer, including breast cancer. The NCCN offers breast cancer guidelines in three forms:

1. breast cancer screening and risk assessment,

2. breast cancer treatment, and

3. breast cancer survivorship care.

Breast cancer screening and risk assessment

The National Comprehensive Cancer Network (NCCN) provides guidelines for breast cancer screenings and risk assessment. These guidelines are based on the latest research and are intended to assist healthcare providers in making decisions about the best approach to breast cancer screening and prevention. Here are some key points from the NCCN guidelines:

1. Breast cancer screening should begin at age 40 for women of average risk.

2. Women with a family history of breast cancer or other risk factors may need to begin screening earlier or have more frequent screening.

3. Mammography is the preferred method of breast cancer screening for women of average risk. However there are additional screening modalities such as Tomosynthesis, or 3D mammograms, Contrast-Enhanced Mammograms, Ultrasound, and MRI.

4. Breast MRI may be used in addition to mammography for women with a high risk of breast cancer.

5. Breast cancer risk assessment should be performed for all women to determine their risk level.

6. Risk factors that increase a woman's risk of breast cancer include age, family history of breast cancer, personal history of breast cancer, certain genetic mutations, and other factors.

7. Women at high risk of breast cancer may benefit from risk reduction strategies, such as chemoprevention or prophylactic surgery.
   

Breast cancer treatment guidelines

The "standard of care" for a breast cancer diagnosis varies depending on the severity and stage of the disease, as well as the patient's unique situation. Examples of breast cancer patients' unique situations can include their age, health history, activity level, genetic predisposition to breast cancer, and the type of breast cancer they have.

What are breast cancer treatment options? The NCCN breast cancer treatment guidelines provide the latest information on breast cancer treatments for early and advanced stages of breast cancer.

Early stage breast cancer typically includes localized breast cancers, such as ductal carcinoma in situ (DCIS) or invasive breast cancer of any size with no evidence of spread to lymph nodes. Treatment options may include breast-conserving surgery, chemotherapy, radiation therapy, and/or hormone therapy.

Advanced breast cancer typically includes breast cancers that have spread to other parts of the body or are resistant to standard treatments. Treatment options may include chemotherapy, targeted therapies (such as monoclonal antibodies), immunotherapy, and endocrine therapy.

It's important to note that the best breast cancer treatment will depend on the individual patient and their specific diagnosis. The NCCN breast cancer treatment guidelines provide information about breast cancer types and recommended treatments for each type. However, it is important for patients to discuss all available treatment options with their health care provider to make an informed decision together.

The NCCN also provides guidance specific subtypes of Breast Cancer

The type of breast cancer should be taken into account when choosing treatments. There are different types of breast cancer, including ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), and triple-negative breast cancer (TNBC), among others. Each type of breast cancer may have different characteristics and respond differently to treatment. Therefore, the choice of treatment should be based on the specific type of breast cancer a person has.

For example, hormonal therapy is typically recommended for women with hormone receptor-positive breast cancer, as these cancers grow in response to estrogen or progesterone. Chemotherapy may be recommended for women with aggressive or high-risk breast cancers, such as triple-negative breast cancer. Women with HER2-positive breast cancer may be treated with targeted therapies, such as Herceptin.

What is the standard treatment for Stage 1 breast cancer?

Here are some key points from the NCCN guidelines for the standard treatment of stage 1 breast cancer:

1. Surgery: The standard treatment for stage 1 breast cancer is surgical removal of the tumor. The type of surgery recommended may depend on the size and location of the tumor, as well as the patient's preference and other factors. Options include breast-conserving surgery (lumpectomy) or mastectomy.

2. Radiation therapy: Following breast-conserving surgery, radiation therapy is typically recommended to reduce the risk of the cancer returning. Radiation therapy may not be necessary after mastectomy unless there are certain high-risk features of the tumor.

3. Hormonal therapy: If the tumor is hormone receptor-positive, hormonal therapy may be recommended to reduce the risk of the cancer returning. Hormonal therapy may be given for several years and can include drugs such as tamoxifen or aromatase inhibitors.

4. Chemotherapy: Chemotherapy may be recommended for some women with stage 1 breast cancer, particularly if the tumor is larger or there are other high-risk features. The decision to recommend chemotherapy should be made in consultation with a healthcare provider and may depend on factors such as age, overall health, and other individual factors.

What is the standard of care for triple negative breast cancer (TNBC)?

Triple-negative breast cancer (TNBC) is a type of breast cancer that is negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Due to its aggressive nature and lack of targeted therapies, the standard of care for TNBC differs from other types of breast cancer. Here are some key points about the standard of care for TNBC:

1. Neoadjuvant chemotherapy: TNBC is often treated with neoadjuvant chemotherapy, which is chemotherapy given before surgery. This approach can shrink the tumor and make it more likely to be surgically removed.

2. Surgery: Following neoadjuvant chemotherapy, surgery is typically recommended to remove any remaining tumor.

3. Radiation therapy: Radiation therapy is often recommended after surgery to reduce the risk of the cancer coming back.

4. Clinical trials: Due to the lack of targeted therapies for TNBC, participation in clinical trials is often recommended for patients with TNBC.

5. Immunotherapy: Some patients with TNBC may be eligible for treatment with immunotherapy, which is a type of therapy that helps the immune system recognize and attack cancer cells.

Breast Cancer Survivorship Care Guidelines

The National Comprehensive Cancer Network (NCCN) provides guidelines for breast cancer survivorship care. These guidelines are intended to assist healthcare providers in managing the long-term health and well-being of breast cancer survivors. Here are some key points from the NCCN guidelines on breast cancer survivorship:

1. Survivorship care plan: All breast cancer survivors should receive a survivorship care plan, which is a document summarizing the treatments received and outlining a plan for ongoing care and monitoring.

2. Surveillance: Breast cancer survivors should receive regular surveillance for recurrence and new primary breast cancers. The frequency and type of surveillance may depend on the stage and characteristics of the original breast cancer.

3. Late and long-term effects: Breast cancer survivors may experience late and long-term effects of treatment, including lymphedema, cognitive dysfunction, cardiovascular disease, and osteoporosis. Healthcare providers should screen for and manage these effects as needed.

4. Healthy lifestyle: Breast cancer survivors should be encouraged to maintain a healthy lifestyle, including regular exercise, a healthy diet, and avoiding tobacco and excessive alcohol use.

5. Psychological support: Breast cancer survivors may experience psychological distress related to their diagnosis and treatment. Healthcare providers should offer psychological support and referral to mental health professionals as needed.

6. Complementary therapies: Breast cancer survivors may use complementary therapies, such as acupuncture or massage, to manage symptoms or improve quality of life. Healthcare providers should be knowledgeable about these therapies and their potential risks and benefits.
   

Cancer Recurrence and Cancer progression

he National Comprehensive Cancer Network (NCCN) provides guidelines for the management of breast cancer recurrence. These guidelines are intended to assist healthcare providers in managing the care of patients who have experienced a recurrence of breast cancer. Here are some key points from the NCCN guidelines on breast cancer recurrence:

1. Evaluation: Patients with suspected breast cancer recurrence should undergo a thorough evaluation, including physical examination, imaging studies, and biopsy or other tissue sampling as appropriate.

2. Treatment options: The choice of treatment for breast cancer recurrence may depend on the location and extent of the recurrence, as well as the patient's previous treatment history. Treatment options may include surgery, radiation therapy, chemotherapy, targeted therapy, and hormonal therapy.

3. Systemic therapy: Patients with distant or metastatic breast cancer recurrence may benefit from systemic therapy, such as chemotherapy or targeted therapy. The choice of therapy should be based on the individual patient and their cancer characteristics.

4. Supportive care: Patients with breast cancer recurrence may experience physical and emotional symptoms related to their cancer and treatment. Healthcare providers should offer supportive care, including pain management, psychosocial support, and referral to palliative care services if appropriate.

Relatedly, the standard of care for breast cancer progression depends on various factors, such as the type of breast cancer, the location and extent of the progression, and the patient's previous treatment history. In general, the goal of treatment for breast cancer progression is to slow or stop the growth of the cancer and improve the patient's quality of life.

The treatment options for breast cancer progression may include surgery, radiation therapy, chemotherapy, targeted therapy, and hormonal therapy, among others. The choice of treatment may depend on the individual patient and their cancer characteristics.

For example, if the breast cancer has spread to other parts of the body (metastatic breast cancer), systemic therapy such as chemotherapy or targeted therapy may be used to control the cancer. If the progression is localized, surgery and/or radiation therapy may be used to remove or shrink the cancer.

Conclusion

The breast cancer standard of care is an important resource for healthcare professionals and patients alike when exploring breast cancer treatment options. Knowing what treatments are recommended based on current evidence can help both doctors and patients make informed and confident decisions about their care plans. It is also important to keep up to date with breast cancer screening and risk assessment guidelines in order to detect breast cancer early on. Additionally, understanding breast cancer treatment guidelines can help ensure that the best treatments are being utilized for each individual stage of breast cancer. Ultimately, knowledge of breast cancer standard of care and associated guidelines can help patients receive the best care possible.