NCCN Breast Cancer Guidelines (Demo Only)
Guideline Assistant
Example 1
Example 2
Premenopausal HR-Positive/HER2-Negative Treatment Algorithm
BINV-7
CATEGORY_2A
Includes specific considerations for premenopausal patients and recurrence score-based treatment decisions
Inoperable/Locally Advanced Disease Treatment Pathway
BINV-15
CATEGORY_2A
Treatment pathways differ based on response to preoperative therapy and operability status
Treatment of Local Recurrence
BINV-19
CATEGORY_2A
Multidisciplinary approach is especially important in management of breast cancer recurrence. The decision to use RT must factor in any prior radiation and risk of late normal tissue toxicity.
Systemic Treatment of Stage IV Disease
BINV-21
CATEGORY_2A
Bone-targeted therapy recommended for bone metastases; Treatment pathway determined by hormone receptor and HER2 status
Disease Progression Management
BINV-23
CATEGORY_2A
Multiple lines of therapy typically considered; Treatment decisions should account for performance status and patient preferences
Systemic Treatment of ER/PR-Positive HER2-Positive M1 Disease Progression
BINV-25
CATEGORY_2A
Continue HER2-targeted therapy following progression on first-line therapy. The optimal duration of trastuzumab in patients with long-term control is unknown.
Adjuvant Endocrine Therapy Pathway
BINV-K
CATEGORY_2A
All recommendations are category 2A unless otherwise indicated. Important footnotes about menopause definition, bone density assessment, SSRIs impact on tamoxifen, and CDK4/6 inhibitor eligibility criteria.
Gene Expression Assays Table
BINV-N
CATEGORY_2A
Gene expression assays provide prognostic and therapy-predictive information that complements T,N,M and biomarker information. Use of these assays is not required for staging. The 21-gene assay (Oncotype Dx) is preferred by the NCCN Breast Cancer Panel for prognosis and prediction of chemotherapy benefit. Special considerations apply for breast cancer in males.
Systemic Therapy HR+/HER2- Stage IV
BINV-P
CATEGORY_2A
Baseline assessment of bone density recommended for patients receiving aromatase inhibitor who are at risk of osteoporosis. Multiple footnotes regarding CDK4/6 inhibitor selection, OS benefits, and treatment sequencing.
Principles of Monitoring Metastatic Disease
BINV-R
CATEGORY_2A
In patients who have long-term stable disease, the frequency of monitoring can be reduced
Phyllodes Tumor Initial Workup and Treatment
PHYLL-1
CATEGORY_2A
FNA or core biopsy may not distinguish fibroadenoma from phyllodes tumor in some cases. Wide excision means excision with intention of obtaining surgical margins ≥1 cm
Phyllodes Tumor Recurrence
PHYLL-2
CATEGORY_2A
No prospective randomized data supporting use of RT for phyllodes tumors
Paget Disease Treatment
PAGET-2
CATEGORY_2A
Mastectomy is always an option with any manifestation of Paget disease
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