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.

Genetic testing
familial risk
family history

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

Optimal fixation

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

family planning

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.

breast conserving surgery

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.
hypofractionated radiotherapy

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.

shared care
Shared follow-up care

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

palliative care
symptom control
quality of life

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.

Neoadjuvant therapy
hormonal therapy
HER2 receptor status

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.
Triple test
breast symptoms

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

Sentinel node biopsy
breast conserving surgery

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

breast reconstruction

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.

intensive follow-up testing
follow-up care