Table 1. Summary of the main therapeutic options adopted in CancerEst guidelines for the management of non-metastatic invasive breast cancer.
| Neoadjuvant therapy is mandatory for inflammatory breast cancer |
| Neoadjuvant therapy is recommended to reduce T2 or T3 tumours and expect breast conservation |
| Mastectomy is recommended for tumours>40 mm |
| Sentinel node procedure applies only for T0 or T1 unifocal tumours |
| Breast re-excision should be performed when margins are unclear (<3 mm) |
| Re-excision by mastectomy is recommended when tumour size>40 mm after primary surgery |
| Axillary lymphadenectomy is recommended after a sentinel node procedure when either the sentinel node is positive, or an a priori unifocal invasive tumour is finally discovered to be multifocal, or tumour size>20 mm after primary surgery |
| Adjuvant chemotherapy is recommended for tumours >20 mm, or those of grade 3, or of grade 2 with Ki-67 index>20%, or without hormonal receptors, or with positive nodes (N+), or for patients younger than 35. Chemotherapy consists in sequential regimens of anthracyclines and taxanes (eight cycles for N+ tumours and six cycles for N− tumours) |
| HER2+ patients with an indication for adjuvant chemotherapy receive trastuzumab |
| For N– tumours, radiotherapy is mandatory after lumpectomy and might be considered after mastectomy for large invasive tumours (>40 mm) |
| For N+ tumours, radiation includes supraclavicular lymph nodes (1–3 positive nodes) and internal mammary lymph nodes (⩾4 positive nodes) |
| When endocrine therapy is recommended, it includes tamoxifen for premenopausal patients, associated with agonists for patients younger than 35, and aromatase inhibitors for postmenopausal patients |
| Microinvasive tumours are managed like invasive tumours. Lesions made out of a unique invasive tumour associated with a microinvasive focus are considered as bifocal |
| Alternatives to recommended treatments are provided to take into account contraindications and patient preferences |
Abbreviation: HER2=human epidermal growth factor receptor 2.