Breast cancer is the most frequently diagnosed cancer globally and the leading cause of cancer-related death in women. However, the incidence of breast cancer has somewhat stabilized over the past few decades, and breast cancer mortality appears to be declining, suggesting a benefit from the combination of early detection and more effective treatment.
The National Comprehensive Cancer Network® (NCCN®) has published the 20th annual edition of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer—one of the original NCCN Guidelines® published in November 1996.
"It is fascinating to look back at the original NCCN Guidelines for Breast Cancer—so many things have changed," said William J. Gradishar, MD, Professor in Medicine - Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and Chair of the NCCN Guidelines Panel for Breast Cancer. "An incredible amount of progress has been made in surgical procedures and treatment based on tumor characteristics."
From a surgical standpoint, said Dr. Gradishar, axillary lymph node dissection was the standard of care in 1996. Today, the less invasive sentinel lymph node (SLN) biopsy is the standard of care for patients with early-stage breast cancer to determine spread of the disease, which has removed the risk of unnecessary extensive lymph node removal, as well as decreased the risks of post-surgical complications.
"How we thought about adjuvant therapy has changed," said Dr. Gradishar. "Physicians used to look at the number of nodes as a determinant of whether a patient was a candidate for chemotherapy, as well as what kind of chemotherapy was appropriate. Now we use genomic profiling to influence our decision-making. Additionally, the chemotherapy regimens have changed and endocrine therapy options have expanded, as has the duration of therapy."
Indeed, genomic testing and targeted therapies have changed the course of breast cancer treatment. In particular, according to Dr. Gradishar, 20 years ago human epidermal growth factor receptor (HER2)-positive disease was not listed in the guidelines, and today the NCCN Guidelines recommendations include a cadre of successful neoadjuvant and adjuvant chemotherapies for people with HER2-positive disease.
"As the founding chair of the NCCN Guidelines Panel for Breast Cancer, I am especially pleased to announce the 20th annual edition of the NCCN Guidelines for Breast Cancer," said Robert W. Carlson, MD, Chief Executive Officer, NCCN, and Former Chair of the NCCN Guidelines Panel for Breast Cancer. "Over the past two decades, the global focus on breast cancer has grown exponentially and with the expertise and experience of the NCCN Guidelines panel, oncologists around the world have consistently had access to high-quality, high-value treatment recommendations."
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