Early and locally advanced breast cancer: diagnosis and management

We have updated some wording to bring the language and style up to date, without changing the meaning.

We have updated some recommendations to bring them in line with current terminology and practice.

We have combined, clarified or reworded some recommendations to make them clearer and to improve ease of reading.

In recommendation 1.1.4, a link has been added to NICE's guideline on familial breast cancer, which covers information on genetic testing.

Recommendation 1.3.5 has been amended because all recurrence rates should be audited, not just for ductal carcinoma in situ (DCIS).

Recommendation 1.4.6 was partly updated and replaced; the remaining part on biopsy has been retained.

'Multidisciplinary team' was added to recommendation 1.6.7 to make it clear this is where the results should be discussed.

Recommendation 1.7.2 was amended because the original recommendations had not made clear that premenopausal women (and men) should receive tamoxifen first line, and that it should be used in low-risk postmenopausal women as well as if aromatase inhibitors are not tolerated or contraindicated.

Recommendation 1.8.4 was amended to distinguish between this recommendation and the new recommendation for T1a/T1b, so it was felt necessary to add 'T1c and above' to this recommendation. The wording of the trastuzumab recommendations have been amended in line with the current summary of product characteristics and the population added to make the recommendation clearer.

Recommendation 1.9.4 was reworded to exclude those people who were receiving bisphosphonates as adjuvant therapy.

In recommendation 1.10.7, the word 'adequate' was changed to 'with clear margins'.

Recommendation 1.10.9 was changed from 'offer' to 'consider' because it contradicted the new recommendations on margins after surgery for DCIS.

In recommendation 1.10.17, the term 'site of local excision' has been amended to 'tumour bed', and breast-conserving surgery has been removed because this is now covered by additional recommendations.

In recommendation 1.10.19, the term 'axilla and supraclavicular fossa' has been changed to 'regional lymph nodes'.

In recommendation 1.10.20, the term 'ALND' has been changed to 'axillary clearance'.

In recommendation 1.12.17, the guideline committee was aware of new evidence on other selective serotonin reuptake inhibitors (SSRIs) and has amended the wording accordingly but could not be specific because there was no new evidence review in this guideline update.