Diagnosis
n/a
Investigation
n/a
Management
Surgery
- Treat patients with early invasive breast cancer, irrespective of age, with surgery and appropriate systemic therapy, rather than endocrine therapy alone, unless significant comorbidity precludes
- DCIS: breast conserving surgery for DCIS a minimum of 2 mm radial margin of excision, do not perform SLNB routinely in this case
- Pagets local: breast conserving surgery with removal of the nipple-areolar complex as an alternative to mastectomy
- Axilla: sentinel lymph node biopsy (SLNB) / minimal surgery, vs lymph node clearance, to stage axilla if early invasive breast cancer and no evidence of lymph node involvement on USS
- Positive SLNB (macro or micrometastases): further axillary treatment
- Breast Reconstruction: discuss immediate breast reconstruction with all patients who are being
- advised to have a mastectomy
Post-Operative Assessment
- Assess oestrogen receptor (ER) status of all invasive breast cancers
- Test human epidermal growth receptor 2 (HER2) status of all invasive breast cancers
- Consider adjuvant therapy for all patients with early invasive breast cancer post surgery at MDT
Chemotherapy
- Offer Chemotherapy agent Docetaxel to patients with lymph node-positive breast cancer as part of an adjuvant chemotherapy regimen
- Early invasive ER positive breast cancer who are not low risk Initial adjuvant offer Aromatase inhibitor (Anastrozole or Letrozole) if post menopausal or previously treated with tamoxifen
- Offer adjuvant ovarian ablation/suppression in addition to tamoxifen to premenopausal women with ER-positive early invasive breast cancer who decline chemotherapy
Biologics
- Trastuzumab, at 3-week intervals for 1 year or until disease recurrence, as an adjuvant treatment to women with HER2-positive early invasive breast cancer following surgery
Bone Loss
- Early invasive breast cancer should have baseline dual energy X-ray absorptiometry (DEXA) scan if starting adjuvant aromatase inhibitor treatment or have treatment-induced menopause
Radiotherapy
- Early invasive breast cancer who have had breast conserving surgery with clear margins should have breast radiotherapy
- Offer adjuvant radiotherapy to patients with DCIS following adequate breast conserving surgery
- Offer adjuvant chest wall radiotherapy if mastectomy and are at a high risk of local recurrence
- Do not offer radiotherapy following mastectomy to patients with early invasive breast cancer who are at low risk of local recurrence (for example, most patients who are lymph node-negative
Complications
- Lymphodema: inform and give advice regarding avoidance of arm trauma
- Arm Mobility: physio and functional exercises
- Discontinue HRT if diagnosed with breast cancer