Group A – Surgical therapy | ||
---|---|---|
Breast conserving therapy (Reference: Statements 7, 8) | ||
Conforming to guideline recommendations | Non-conforming to guideline recommendations | |
BCT in DCIS and LCIS < 4 cm | BCT when tumor size > 4 cm | |
BCT in R0 | BCT in R1 | |
BCT in presence of multicentricity | ||
BCT in presence of inflammatory carcinoma | ||
Mastectomy (Reference: Statement 9) | ||
Conforming to guideline recommendations | Non-conforming to guideline recommendations | |
Mastectomy for microcalcification of malignant type | No mastectomy in the presence of microcalcification of malignant type | |
Mastectomy for intraductal carcinoma and tumor size > 4 cm | No mastectomy in the presence of multicentricity | |
Mastectomy for multicentricity | Mastectomy for intraductal carcinoma with a tumor size < 4 cm | |
Mastectomy for R1 | No mastectomy for inflammatory breast cancer | |
Mastectomy for inflammatory breast cancer | ||
Axillary dissection (Reference: Statements 12, 13) | ||
Conforming to guideline recommendations | Non-conforming to guideline recommendations | |
Removal of invasive carcinoma + dissection for at least level I and II + removal of at least 10 lymph nodes | Lymph node removal in non-invasive carcinoma | |
Invasive carcinoma + (only dissection for level I or removal of <10 lymph nodes) | ||
Group B – Radiotherapy | ||
Radiotherapy secondary to BCT (Reference: Statements 23, 24) | ||
Conforming to guideline recommendations | Non-conforming to guideline recommendations | |
Radiotherapy secondary to BCT for invasive carcinoma | No radiotherapy secondary to BCT for invasive carcinoma | |
Postmastectomy strategy (Reference: Statements 25, 26) | ||
Conforming to guideline recommendations | Non-conforming to guideline recommendations | |
Radiotherapy secondary to mastectomy and R1/R2 | Radiotherapy in mastectomy and R0 | |
Radiotherapy secondary to mastectomy and nodes involved ≥4 | Radiotherapy in mastectomy and T = T1 or T2 | |
Radiotherapy T = T3 or T4 | No radiotherapy in mastectomy and R1/R2 | |
No radiotherapy in mastectomy and nodes involved ≥4 | ||
No radiotherapy in T = T3 or T4 | ||
Group C –Endocrine therapy | ||
Endocrine therapy (Reference: Statements 33–37) | ||
Conforming to guideline recommendations | Non-conforming to guideline recommendations | |
Tamoxifen for invasive carcinoma in patients with positive hormone receptor status | Hormone therapy in receptor-negative patients | |
GnRH + tamoxifen or GnRH in premenopausal patients with positive hormone receptor status | ||
Postmenopausal patient and positive hormone receptor status and tamoxifen or aromatase inhibitor | ||
Endocrine therapy after chemotherapy in positive receptor status | ||
Tamoxifen for DCIS | ||
When estrogen receptor (ER) and progesterone receptor (PgR) are negative: | ||
Risk group | Chemotherapy | Guideline conformity |
Low | CT performed | Overtherapy |
No CT performed | Guideline conformity | |
Moderate | CMF/EC/AC | Undertherapy |
FEC/T | Guideline conformity | |
No CT performed | Undertherapy | |
High | CMF/EC/AC | Undertherapy |
FEC/T | Guideline conformity | |
No CT performed | Undertherapy | |
ER and PgR >0 and <6 | ||
Risk group | Chemotherapy | Guideline conformity |
Low | CT performed | Overtherapy |
No CT performed | Guideline conformity | |
Moderate | ||
Premenopausal | CT performed | Guideline conformity |
No CT performed | Guideline conformity | |
Postmenopausal | CT performed | Guideline conformity |
No CT performed | Undertherapy | |
High | CMF/EC/AC | Undertherapy |
FEC/T | Guideline conformity | |
No CT performed | Undertherapy | |
ER or PgR ≥6 | Chemotherapy | Guideline conformity |
Risk group | ||
Low | CT performed | Overtherapy |
No CT performed | Guideline conformity | |
Moderate | CT performed | Guideline conformity |
No CT performed | Guideline conformity | |
High | CMF/EC/AC | Undertherapy |
FEC/T | Guideline conformity | |
No CT performed | Undertherapy |