Includes specific considerations for premenopausal patients and recurrence score-based treatment decisions

Treatment pathways differ based on response to preoperative therapy and operability status

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.

Bone-targeted therapy recommended for bone metastases; Treatment pathway determined by hormone receptor and HER2 status

Multiple lines of therapy typically considered; Treatment decisions should account for performance status and patient preferences

Continue HER2-targeted therapy following progression on first-line therapy. The optimal duration of trastuzumab in patients with long-term control is unknown.

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 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.

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.

In patients who have long-term stable disease, the frequency of monitoring can be reduced

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

No prospective randomized data supporting use of RT for phyllodes tumors

Mastectomy is always an option with any manifestation of Paget disease