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.

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

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

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.

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.

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.

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

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.

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

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