Early and locally advanced breast cancer: diagnosis and management

Research recommendations coming out of this guidance

• Surgery to the breast:- What is the optimum tumour-free margin width after breast-conserving surgery for women with ductal carcinoma in situ (DCIS) and invasive breast cancer?
  
  

• Efectiveness of 26 Gy in 5 fractions over 1 week regimen in people receiving nodal irradiation- What is the effectiveness of radiotherapy given in 26 Gy in 5 fractions over 1 week compared with 40 Gy in 15 fractions over 3 weeks in people with early or locally advanced invasive breast cancer who are also offered nodal irradiation?

• Adjuvant bisphosphonate therapy:- Which groups of people with early and locally advanced breast cancer would benefit from the use of adjuvant bisphosphonates?

• Breast reconstruction:- What are the long-term outcomes for breast reconstruction in women having radiotherapy to the chest wall?

• Neoadjuvant endocrine therapy in premenopausal women:- Is neoadjuvant endocrine therapy safe in premenopausal women with early breast cancer?

• Neoadjuvant endocrine therapy in postmenopausal women:- Is there a benefit for neoadjuvant endocrine therapy in postmenopausal women with early breast cancer?

• Neoadjuvant treatment:- What are the indications for postmastectomy radiotherapy after neoadjuvant chemotherapy?

• What is the most effective and cost-effective way of delivering the intervention (for example, type of physiotherapy or exercise, mode of delivery, number of sessions) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the acceptability of the intervention for different groups, such as:

  women, men, trans people and non-binary people

  people from minority ethnic family backgrounds

  people with learning disabilities or cognitive impairment, or physical disabilities, or both

  neurodiverse people?

• Strategies to reduce arm and shoulder problems- What is the most effective and cost-effective way of delivering the intervention (for example, type of physiotherapy or exercise, mode of delivery, number of sessions) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the acceptability of the intervention for different groups, such as:

  women, men, trans people and non-binary people

  people from minority ethnic family backgrounds

  people with learning disabilities or cognitive impairment, or physical disabilities, or both

  neurodiverse people?

• What is the adherence to, and satisfaction with, different intervention formats (for example, individual, group, virtual, and face to face) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the impact of greater adherence on effectiveness for different groups, such as:

  women, men, trans people and non-binary people

  people from minority ethnic family backgrounds

  people with learning disabilities or cognitive impairment, or physical disabilities, or both

  neurodiverse people?

• What is the adherence to, and satisfaction with, different intervention formats (for example, individual, group, virtual, and face to face) to reduce arm and shoulder problems after breast cancer surgery or radiotherapy, and what is the impact of greater adherence on effectiveness for different groups, such as:

  women, men, trans people and non-binary people

  people from minority ethnic family backgrounds

  people with learning disabilities or cognitive impairment, or physical disabilities, or both

  neurodiverse people?

• Effectivness of 26 Gy in 5 fractions over 1 week regimen in people receiving breast construction- What is the effectiveness of radiotherapy given in 26 Gy in 5 fractions over 1 week compared with 40 Gy in 15 fractions over 3 weeks in people with early or locally advanced invasive breast cancer who are offered breast reconstruction?