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CANCER AUSTRALIA STATEMENTS

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  • Breast cancer
  • Metastatic breast cancer

Influencing best practice in breast cancer

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  • About the Statement
  • How the Statement was developed
  • The 12 Practices
  • Consumer Fact Sheets
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  • About the Statement
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  • The 12 Practices
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Influencing best practice in Breast cancer

The Cancer Australia Statement – Influencing best practice in breast cancer is a summary of 12 practices that have been identified as appropriate or inappropriate for the provision of breast cancer care in Australia.

The Statement supports patient-centred, multidisciplinary cancer care, and is intended to complement the nationally endorsed Optimal care pathway for women with breast cancer.  It highlights what ‘ought to be done’ in breast cancer care to maximise clinical benefit, minimise harm and deliver patient-centred care.

Cancer Australia led a highly collaborative, consultative and evidence-based approach to achieve consensus and relevance to the Australian context.  The practices are underpinned by evidence, and have the support of all key clinical, cancer and consumer organisations.

The 12 Practices

Appropriate to offer genetic counselling to women with a high familial risk at or around the time that they are diagnosed with breast cancer, with a view to genetic testing to inform decision-making about treatment.

Practice 1 YouTube video
Consumer Information
Genetic testing
familial risk
family history
view

Appropriate to ensure optimal fixation of breast cancer specimens for accurate pathological examination and biomarker assessment.

Practice 2 YouTube video
Consumer Information
Optimal fixation
pathology
biomarker
view

Appropriate to consider and discuss fertility and family planning with premenopausal women before they undergo breast cancer treatment.

Practice 3 YouTube video
Consumer Information
Fertility
family planning
view

Appropriate to offer a choice of either breast conserving surgery followed by radiotherapy, or a mastectomy to patients diagnosed with early breast cancer, as these treatments are equally effective in terms of survival.

Practice 4 YouTube video
Consumer Information
breast conserving surgery
mastectomy
view

Appropriate to offer a shorter, more intense course of radiotherapy (hypofractionated radiotherapy) as an alternative to conventional radiotherapy for patients with early breast cancer who:

  • are aged 50 years and over;
  • have a cancer at an early pathological stage (T1-2, N0, M0); and
  • have undergone breast conserving surgery with clear surgical margins.
Practice 5 YouTube video
Consumer Information
hypofractionated radiotherapy
treatment
view

Appropriate to offer patients with early breast cancer the opportunity for their follow-up care to be shared between a primary care physician and a specialist, to provide more accessible, whole-person care.

Practice 6 YouTube video
Consumer Information
Shared follow-up care
shared care
follow-up
view

Appropriate to offer palliative care early in the management of patients with symptomatic, metastatic breast cancer to improve symptom control and quality of life.

Practice 7 YouTube video
Consumer Information
palliative care
symptom control
quality of life
view

Appropriate to consider the pre-operative use of chemotherapy or hormonal therapy (systemic, neoadjuvant therapy) informed by hormone and HER2 receptor status, for all patients where these therapies are clinically indicated.

Practice 8 YouTube video
Consumer Information
Neoadjuvant therapy
hormonal therapy
HER2 receptor status
view

Not appropriate to confirm or exclude a diagnosis of breast cancer without undertaking the triple test, which involves:

  • taking a patient history and clinical breast examination;
  • imaging tests (mammogram and/or ultrasound); and
  • biopsy to remove cells or tissue for examination.
Practice 9 YouTube video
Consumer Information
Triple test
investigating
breast symptoms
view

Not appropriate to offer a sentinel node biopsy to patients diagnosed with DCIS (ductal carcinoma in situ) having breast conserving surgery, unless clinically indicated.

Practice 10 YouTube video
Consumer Information
Sentinel node biopsy
DCIS
breast conserving surgery
view

Not appropriate to perform a mastectomy without first discussing with the patient the options of immediate or delayed breast reconstruction.

Practice 11 YouTube video
Consumer Information
mastectomy
breast reconstruction
view

Not appropriate to perform intensive testing (full blood count, biochemistry or tumour markers) or imaging (chest X-ray, PET, CT and radionuclide bone scans) as part of standard follow-up of patients who have been treated for early breast cancer and who are not experiencing symptoms.

Practice 12 YouTube video
Consumer Information
intensive follow-up testing
follow-up care
view
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