The 12 Practices | Cancer Australia

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.

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Genetic testing

familial risk

family history

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

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Optimal fixation

pathology

biomarker

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

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Fertility

family planning

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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.

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breast conserving surgery

mastectomy

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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.

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hypofractionated radiotherapy

treatment

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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.

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Shared follow-up care

shared care

follow-up

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

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palliative care

symptom control

quality of life

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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.

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Neoadjuvant therapy

hormonal therapy

HER2 receptor status

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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.

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Triple test

investigating

breast symptoms

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

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Sentinel node biopsy

DCIS

breast conserving surgery

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

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mastectomy

breast reconstruction

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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.

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intensive follow-up testing

follow-up care

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