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Breast Neoplasms HELP
Based on 100,000 articles published since 2008
|||| 71 

These are the 100000 published articles about Breast Neoplasms that originated from Worldwide during 2008-2018.
 
+ Citations + Abstracts
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1 Guideline Updated ASTRO guidelines on accelerated partial breast irradiation (APBI): to whom can we offer APBI outside a clinical trial? 2018

Kirby, Anna M. ·1 Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research , Sutton , UK. ·Br J Radiol · Pubmed #29513031.

ABSTRACT: The American Society of Radiation Oncology has recently updated its guidelines on the role of accelerated partial breast irradiation in the management of breast cancer. This commentary discusses the new recommendations and how we might advise patients in the light of existing data.

2 Guideline The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation. 2018

Shah, Chirag / Vicini, Frank / Shaitelman, Simona F / Hepel, Jaroslaw / Keisch, Martin / Arthur, Douglas / Khan, Atif J / Kuske, Robert / Patel, Rakesh / Wazer, David E. ·Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH. Electronic address: csshah27@hotmail.com. · 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI. · Department of Radiation Oncology, The University of MD Anderson Cancer Center, Houston, TX. · Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Brown University, Providence, RI. · Cancer Healthcare Associates, Miami, FL. · Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA. · Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. · Arizona Breast Cancer Specialists, Scottsdale, AZ. · Department of Radiation Oncology, Sutter Health, Los Gatos, CA. ·Brachytherapy · Pubmed #29074088.

ABSTRACT: PURPOSE: Adjuvant radiation after breast-conserving surgery remains the standard-of-care treatment for patients with ductal carcinoma in situ and early-stage invasive breast cancer. Multiple alternatives to standard whole-breast irradiation exist including accelerated partial-breast irradiation (APBI). Therefore, the purpose of this APBI guideline is to provide updated data for clinicians as well as recommendations regarding appropriate patient selection and techniques to deliver APBI. METHODS: Members of the American Brachytherapy Society with expertise in breast cancer and breast brachytherapy in particular created an updated guideline for appropriate patient selection based on an extensive literature search and clinical experience. In addition, data were evaluated with respect to APBI techniques and recommendations presented. RESULTS: Appropriate candidates for APBI include patients aged 45 years or older, all invasive histologies and ductal carcinoma in situ, tumors 3 cm or less, node negative, estrogen receptor positive/negative, no lymphovascular space invasion, and negative margins. With respect to techniques, the strongest evidence is for interstitial brachytherapy and intensity-modulated radiation therapy APBI with moderate evidence to support applicator brachytherapy or three-dimensional conformal radiotherapy APBI. Intraoperative radiation therapy and electronic brachytherapy should not be offered regardless of technique outside of clinical trial. CONCLUSIONS: The updated guidelines presented offer clinicians with a summary of data supporting APBI and guidelines for the appropriate and safe utilization of the technique.

3 Guideline ACR Appropriateness Criteria 2017

Anonymous2491088 / Slanetz, Priscilla J / Moy, Linda / Baron, Paul / diFlorio, Roberta M / Green, Edward D / Heller, Samantha L / Holbrook, Anna I / Lee, Su-Ju / Lewin, Alana A / Lourenco, Ana P / Niell, Bethany / Stuckey, Ashley R / Trikha, Sunita / Vincoff, Nina S / Weinstein, Susan P / Yepes, Monica M / Newell, Mary S. ·Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: pslanetz@bidmc.harvard.edu. · Panel Vice Chair, NYU Clinical Cancer Center, New York, New York. · Roper St. Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. · The University of Mississippi Medical Center, Jackson, Mississippi. · New York University School of Medicine, New York, New York. · Emory University Hospital, Atlanta, Georgia. · University of Cincinnati, Cincinnati, Ohio. · Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island. · Moffitt Cancer Center, Tampa, Florida. · Women and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists. · Northwell Health, Syosset, New York. · Hofstra Northwell School of Medicine, Manhasset, New York. · Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. · University of Miami, Miami, Florida. · Panel Chair, Emory University Hospital, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #29101985.

ABSTRACT: Patients with locally advanced invasive breast cancers are often treated with neoadjuvant chemotherapy prior to definitive surgical intervention. The primary aims of this approach are to: 1) reduce tumor burden thereby permitting breast conservation rather than mastectomy; 2) promptly treat possible metastatic disease, whether or not it is detectable on preoperative staging; and 3) potentially tailor future chemotherapeutic decisions by monitoring in-vivo tumor response. Accurate radiological assessment permits optimal management and planning in this population. However, assessment of tumor size and response to treatment can vary depending on the modality used, the measurement technique (such as single longest diameter, 3-D measurements, or calculated tumor volume), and varied response of different tumor subtypes to neoadjuvant chemotherapy (such as concentric shrinkage or tumor fragmentation). As discussed in further detail, digital mammography, digital breast tomosynthesis, US and MRI represent the key modalities with potential to help guide patient management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

4 Guideline ACR Appropriateness Criteria 2017

Anonymous2481088 / Oliva, Isabel B / Day, Kevin / Dill, Karin E / Hanley, Michael / Ahmed, Osmanuddin / Bennett, Shelby J / Desjardins, Benoit / Gage, Kenneth L / Ginsburg, Michael / Hamawy, Adam H / Steigner, Michael L / Strax, Richard / Verma, Nupur / Rybicki, Frank J. ·Principal Author, Yale University School of Medicine, New Haven, Connecticut. Electronic address: isabel.oliva@yale.edu. · Research Author, Stanford University, Stanford, California. · Panel Chair, UMass Memorial Medical Center, Worcester, Massachusetts. · Panel Vice Chair, University of Virginia Health System, Charlottesville, Virginia. · Rush University Medical Center, Chicago, Illinois. · University of Chicago, Chicago, Illinois. · University of Pennsylvania, Philadelphia, Pennsylvania. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. · Palos Community Hospital, Palos Heights, Illinois. · Princeton Plastic Surgeons, Princeton, New Jersey; American College of Surgeons. · Brigham & Women's Hospital, Boston, Massachusetts. · Baylor College of Medicine, Houston, Texas. · University of Florida, Gainesville, Florida. · Specialty Chair, Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada. ·J Am Coll Radiol · Pubmed #29101984.

ABSTRACT: Breast cancer is the most common malignancy in women in the United States. Breast reconstruction surgery is a commonly used therapy for patients with breast cancer. The technique for the deep inferior epigastric perforator flap uses a preserved rectus muscle, which decreases donor site morbidity. Accurate identification and measurement of the perforator branches of the deep inferior epigastric artery is pivotal during pre-operative planning so that the surgeon can prioritize the best vessel to use and ultimately improve clinical outcome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

5 Guideline ACR Appropriateness Criteria 2017

Anonymous2431088 / Mainiero, Martha B / Moy, Linda / Baron, Paul / Didwania, Aarati D / diFlorio, Roberta M / Green, Edward D / Heller, Samantha L / Holbrook, Anna I / Lee, Su-Ju / Lewin, Alana A / Lourenco, Ana P / Nance, Kara J / Niell, Bethany L / Slanetz, Priscilla J / Stuckey, Ashley R / Vincoff, Nina S / Weinstein, Susan P / Yepes, Monica M / Newell, Mary S. ·Principal Author, Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: mmainiero@lifespan.org. · Panel Vice Chair, NYU Clinical Cancer Center, New York, New York. · Roper St. Francis Physician Partners Breast Surgery, Charleston, South Carolina; American College of Surgeons. · Northwestern University Feinberg School of Medicine, Chicago, Illinois; American College of Physicians. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. · The University of Mississippi Medical Center, Jackson, Mississippi. · New York University School of Medicine, New York, New York. · Emory University Hospital, Atlanta, Georgia. · University of Cincinnati Medical Center, Cincinnati, Ohio. · Alpert Medical School of Brown University, Providence, Rhode Island. · Wellessence MD, Schaumburg, Illinois; American College of Physicians. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Women and Infants Hospital, Providence, Rhode Island; American Congress of Obstetricians and Gynecologists. · Hofstra Northwell School of Medicine, Manhasset, New York. · Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania. · University of Miami, Miami, Florida. · Panel Chair, Emory University Hospital, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #29101979.

ABSTRACT: Breast cancer screening recommendations are based on risk factors. For average-risk women, screening mammography and/or digital breast tomosynthesis is recommended beginning at age 40. Ultrasound (US) may be useful as an adjunct to mammography for incremental cancer detection in women with dense breasts, but the balance between increased cancer detection and the increased risk of a false-positive examination should be considered in the decision. For intermediate-risk women, US or MRI may be indicated as an adjunct to mammography depending upon specific risk factors. For women at high risk due to prior mantle radiation between the ages of 10 to 30, mammography is recommended starting 8 years after radiation therapy but not before age 25. For women with a genetic predisposition, annual screening mammography is recommended beginning 10 years earlier than the affected relative at the time of diagnosis but not before age 30. Annual screening MRI is recommended in high-risk women as an adjunct to mammography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

6 Guideline Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology-Cancer Care Ontario Focused Guideline Update. 2017

Van Poznak, Catherine / Somerfield, Mark R / Barlow, William E / Biermann, J Sybil / Bosserman, Linda D / Clemons, Mark J / Dhesy-Thind, Sukhbinder K / Dillmon, Melissa S / Eisen, Andrea / Frank, Elizabeth S / Jagsi, Reshma / Jimenez, Rachel / Theriault, Richard L / Vandenberg, Theodore A / Yee, Gary C / Moy, Beverly. ·Catherine Van Poznak, J. Sybil Biermann, and Reshma Jagsi, University of Michigan, Ann Arbor, MI; Mark R. Somerfield, American Society of Clinical Oncology, Alexandria, VA; William E. Barlow, Cancer Research and Biostatistics, Seattle, WA; Linda D. Bosserman, City of Hope, Duarte, CA; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa; Sukhbinder K. Dhesy-Thind, Juravinski Hospital and Cancer Centre, Hamilton; Andrea Eisen, Theodore A. Vandenberg, London Regional Cancer Program, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Dana-Farber Cancer Institute; Rachel Jimenez, Beverly Moy, Massachusetts General Hospital, Boston, MA; Richard L. Theriault, MD Anderson Cancer Center, Houston, TX; and Gary C. Yee, University of Nebraska Medical Center, Omaha, NE. ·J Clin Oncol · Pubmed #29035643.

ABSTRACT: Purpose To update, in collaboration with Cancer Care Ontario (CCO), key recommendations of the American Society of Clinical Oncology (ASCO) guideline on the role of bone-modifying agents (BMAs) in metastatic breast cancer. This focused update addressed the new data on intervals between dosing and the role of BMAs in control of bone pain. Methods A joint ASCO-CCO Update Committee conducted targeted systematic literature reviews to identify relevant studies. Results The Update Committee reviewed three phase III noninferiority trials of dosing intervals, one systematic review and meta-analysis of studies of de-escalation of BMAs, and two randomized trials of BMAs in control of pain secondary to bone metastases. Recommendations Patients with breast cancer who have evidence of bone metastases should be treated with BMAs. Options include denosumab, 120 mg subcutaneously, every 4 weeks; pamidronate, 90 mg intravenously, every 3 to 4 weeks; or zoledronic acid, 4 mg intravenously every 12 weeks or every 3 to 4 weeks. The analgesic effects of BMAs are modest, and they should not be used alone for bone pain. The Update Committee recommends that the current standard of care for supportive care and pain management-analgesia, adjunct therapies, radiotherapy, surgery, systemic anticancer therapy, and referral to supportive care and pain management-be applied. Evidence is insufficient to support the use of one BMA over another. Additional information is available at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .

7 Guideline American College of Radiology-American Brachytherapy Society practice parameter for electronically generated low-energy radiation sources. 2017

Devlin, Phillip M / Gaspar, Laurie E / Buzurovic, Ivan / Demanes, D Jeffrey / Kasper, Michael E / Nag, Subir / Ouhib, Zoubir / Petit, Joshua H / Rosenthal, Seth A / Small, William / Wallner, Paul E / Hartford, Alan C. ·Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA. Electronic address: pdevlin@bwh.harvard.edu. · University of Colorado Denver, Aurora, CO. · Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA. · UCLA Health System, Los Angeles, CA. · Lynn Regional Cancer Center, Boca Raton, FL. · Kaiser Permanente, Santa Clara, CA. · Lynn Regional Cancer Center, Delray Beach, FL. · Poudre Valley Hospital, Fort Collins, CO. · Roseville Radiation Oncology, Roseville, CA. · Loyola University Medical Center, Maywood, IL. · National Cancer Institute, Rockville, MD. · Dartmouth-Hitchcock Medical Center, Lebanon, NH. ·Brachytherapy · Pubmed #28988661.

ABSTRACT: BACKGROUND: This collaborative practice parameter technical standard has been created between the American College of Radiology and American Brachytherapy Society to guide the usage of electronically generated low energy radiation sources (ELSs). It refers to the use of electronic X-ray sources with peak voltages up to 120 kVp to deliver therapeutic radiation therapy. MAIN FINDINGS: The parameter provides a guideline for utilizing ELS, including patient selection and consent, treatment planning, and delivery processes. The parameter reviews the published clinical data with regard to ELS results in skin, breast, and other cancers. CONCLUSIONS: This technical standard recommends appropriate qualifications of the involved personnel. The parameter reviews the technical issues relating to equipment specifications as well as patient and personnel safety. Regarding suggestions for educational programs with regard to this parameter,it is suggested that the training level for clinicians be equivalent to that for other radiation therapies. It also suggests that ELS must be done using the same standards of quality and safety as those in place for other forms of radiation therapy.

8 Guideline Quality indicators in breast cancer care: An update from the EUSOMA working group. 2017

Biganzoli, Laura / Marotti, Lorenza / Hart, Christopher D / Cataliotti, Luigi / Cutuli, Bruno / Kühn, Thorsten / Mansel, Robert E / Ponti, Antonio / Poortmans, Philip / Regitnig, Peter / van der Hage, Jos A / Wengström, Yvonne / Rosselli Del Turco, Marco. ·Nuovo Ospedale di Prato, Prato, Italy. Electronic address: laura.biganzoli@uslcentro.toscana.it. · Eusoma, Florence, Italy. · Nuovo Ospedale di Prato, Prato, Italy; St. Vincent's Hospital, Melbourne, Victoria, Australia. · Bccert and Senonetwork, Florence, Italy. · Institut du Cancer Courlancy, Reims, France. · Klinikum Esslingen, Esslingen, Germany. · Cardiff University, Cardiff, United Kingdom. · CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy. · Institut Curie, Paris, France. · Medical University of Graz, Graz, Austria. · Antoni van Leeuwenhoek, The Netherland Cancer Institute, Amsterdam, The Netherlands. · Karolinska Institutet, Stockholm, Sweden. · Radiology, Rome, Italy. ·Eur J Cancer · Pubmed #28963914.

ABSTRACT: In 2010, EUSOMA published a position paper, describing a set of benchmark quality indicators (QIs) that could be adopted by breast centres to allow standardised auditing and quality assurance and to establish an agreed minimum standard of care. Towards the end of 2014, EUSOMA decided to update the paper on QIs to consider and incorporate new scientific knowledge in the field. Several new QIs have been included to address the need for improved follow-up care of patients following primary treatments. With regard to the management of elderly patients, considering the complexity, the expert group decided that, for some specific quality indicators, if centres fail to meet the minimum standard, older patients will be excluded from analysis, provided that reasons for non-adherence to the QI are specified in the clinical chart and are identified at the review of the clinical records. In this way, high standards are promoted, but centres are able to identify and account for the effect of non-standard treatment in the elderly. In the paper, there is no QI for outcome measurements, such as relapse rate or overall survival. However, it is hoped that this will be developed in time as the databases mature and user experience increases. All breast centres are required to record outcome data as accurately and comprehensively as possible to allow this to occur. In the paper, different initiatives undertaken at international and national level to audit quality of care through a set of QIs have been mentioned.

9 Guideline Appendix 2: Advanced breast cancer: MCBS eUpdate published online 25 April 2017 (www.esmo.org/Guidelines/Breast-Cancer). 2017

Anonymous2201202. · ·Ann Oncol · Pubmed #28881923.

ABSTRACT: -- No abstract --

10 Guideline Practice Bulletin No 182: Hereditary Breast and Ovarian Cancer Syndrome. 2017

Anonymous631200. · ·Obstet Gynecol · Pubmed #28832484.

ABSTRACT: Hereditary breast and ovarian cancer syndrome is an inherited cancer-susceptibility syndrome characterized by multiple family members with breast cancer, ovarian cancer, or both. Based on the contemporary understanding of the origins and management of ovarian cancer and for simplicity in this document, ovarian cancer also refers to fallopian tube cancer and primary peritoneal cancer. Clinical genetic testing for gene mutations allows more precise identification of those women who are at an increased risk of inherited breast cancer and ovarian cancer. For these individuals, screening and prevention strategies can be instituted to reduce their risks. Obstetrician-gynecologists play an important role in the identification and management of women with hereditary breast and ovarian cancer syndrome. If an obstetrician-gynecologist or other gynecologic care provider does not have the necessary knowledge or expertise in cancer genetics to counsel a patient appropriately, referral to a genetic counselor, gynecologic or medical oncologist, or other genetics specialist should be considered (1). More genes are being discovered that impart varying risks of breast cancer, ovarian cancer, and other types of cancer, and new technologies are being developed for genetic testing. This Practice Bulletin focuses on the primary genetic mutations associated with hereditary breast and ovarian cancer syndrome, BRCA1 and BRCA2, but also will briefly discuss some of the other genes that have been implicated.

11 Guideline Practice Bulletin No. 182 Summary: Hereditary Breast and Ovarian Cancer Syndrome. 2017

Anonymous551200. · ·Obstet Gynecol · Pubmed #28832475.

ABSTRACT: Hereditary breast and ovarian cancer syndrome is an inherited cancer-susceptibility syndrome characterized by multiple family members with breast cancer, ovarian cancer, or both. Based on the contemporary understanding of the origins and management of ovarian cancer and for simplicity in this document, ovarian cancer also refers to fallopian tube cancer and primary peritoneal cancer. Clinical genetic testing for gene mutations allows more precise identification of those women who are at an increased risk of inherited breast cancer and ovarian cancer. For these individuals, screening and prevention strategies can be instituted to reduce their risks. Obstetrician-gynecologists play an important role in the identification and management of women with hereditary breast and ovarian cancer syndrome. If an obstetrician-gynecologist or other gynecologic care provider does not have the necessary knowledge or expertise in cancer genetics to counsel a patient appropriately, referral to a genetic counselor, gynecologic or medical oncologist, or other genetics specialist should be considered (1). More genes are being discovered that impart varying risks of breast cancer, ovarian cancer, and other types of cancer, and new technologies are being developed for genetic testing. This Practice Bulletin focuses on the primary genetic mutations associated with hereditary breast and ovarian cancer syndrome, BRCA1 and BRCA2, but also will briefly discuss some of the other genes that have been implicated.

12 Guideline AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON MENOPAUSE-2017 UPDATE. 2017

Cobin, Rhoda H / Goodman, Neil F / Anonymous2741041. · ·Endocr Pract · Pubmed #28703650.

ABSTRACT: EXECUTIVE SUMMARY This American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) Position Statement is designed to update the previous menopause clinical practice guidelines published in 2011 but does not replace them. The current document reviews new clinical trials published since then as well as new information regarding possible risks and benefits of therapies available for the treatment of menopausal symptoms. AACE reinforces the recommendations made in its previous guidelines and provides additional recommendations on the basis of new data. A summary regarding this position statement is listed below: New information available from randomized clinical trials and epidemiologic studies reported after 2011 was critically reviewed. No previous recommendations from the 2011 menopause clinical practice guidelines have been reversed or changed. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, selective estrogen-receptor modulators (SERMs), and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, SERMs, and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. New recommendations in this position statement include: 1. RECOMMENDATION: the use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for cardiovascular disease, age, and time from menopause. 2. RECOMMENDATION: the use of transdermal as compared with oral estrogen preparations may be considered less likely to produce thrombotic risk and perhaps the risk of stroke and coronary artery disease. 3. RECOMMENDATION: when the use of progesterone is necessary, micronized progesterone is considered the safer alternative. 4. RECOMMENDATION: in symptomatic menopausal women who are at significant risk from the use of hormone replacement therapy, the use of selective serotonin re-uptake inhibitors and possibly other nonhormonal agents may offer significant symptom relief. 5. RECOMMENDATION: AACE does not recommend use of bioidentical hormone therapy. 6. RECOMMENDATION: AACE fully supports the recommendations of the Comité de l'Évolution des Pratiques en Oncologie regarding the management of menopause in women with breast cancer. 7. RECOMMENDATION: HRT is not recommended for the prevention of diabetes. 8. RECOMMENDATION: In women with previously diagnosed diabetes, the use of HRT should be individualized, taking in to account age, metabolic, and cardiovascular risk factors. ABBREVIATIONS: AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; BMI = body mass index; CAC = coronary artery calcification; CEE = conjugated equine estrogen; CEPO = Comité de l'Évolution des Pratiques en Oncologie; CAD = coronary artery disease; CIMT = carotid intima media thickness; CVD = cardiovascular disease; FDA = Food and Drug Administration; HDL = high-density lipoprotein; HRT = hormone replacement therapy; HT = hypertension; KEEPS = Kronos Early Estrogen Prevention Study; LDL = low-density lipoprotein; MBS = metabolic syndrome; MPA = medroxyprogesterone acetate; RR = relative risk; SERM = selective estrogen-receptor modulator; SSRI = selective serotonin re-uptake inhibitor; VTE = venous thrombo-embolism; WHI = Women's Health Initiative.

13 Guideline Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update. 2017

Krop, Ian / Ismaila, Nofisat / Andre, Fabrice / Bast, Robert C / Barlow, William / Collyar, Deborah E / Hammond, M Elizabeth / Kuderer, Nicole M / Liu, Minetta C / Mennel, Robert G / Van Poznak, Catherine / Wolff, Antonio C / Stearns, Vered. ·Ian Krop, Dana-Farber Cancer Institute, Boston, MA; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Fabrice Andre, Institute Gustave Roussy, Paris, France; Robert C. Bast, The University of Texas MD Anderson Cancer Center, Houston; Robert G. Mennel, Baylor University Medical Center, Texas Oncology PA, Dallas, TX; William Barlow, Cancer Research and Biostatistics, Seattle, WA; Deborah E. Collyar, Patient Advocates in Research, Danville, CA; M. Elizabeth Hammond, University of Utah and Intermountain Health Care, Salt Lake City, UT; Nicole M. Kuderer, University of Washington Medical Center, Seattle, WA; Minetta C. Liu, Mayo Clinic College of Medicine, Rochester, MN; Catherine Van Poznak, University of Michigan, Ann Arbor, MI; and Antonio C. Wolff and Vered Stearns, Johns Hopkins University, Baltimore, MD. ·J Clin Oncol · Pubmed #28692382.

ABSTRACT: Purpose This focused update addresses the use of MammaPrint (Agendia, Irvine, CA) to guide decisions on the use of adjuvant systemic therapy. Methods ASCO uses a signals approach to facilitate guideline updates. For this focused update, the publication of the phase III randomized MINDACT (Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy) study to evaluate the MammaPrint assay in 6,693 women with early-stage breast cancer provided a signal. An expert panel reviewed the results of the MINDACT study along with other published literature on the MammaPrint assay to assess for evidence of clinical utility. Recommendations If a patient has hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-negative breast cancer, the MammaPrint assay may be used in those with high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy due to its ability to identify a good-prognosis population with potentially limited chemotherapy benefit. Women in the low clinical risk category did not benefit from chemotherapy regardless of genomic MammaPrint risk group. Therefore, the MammaPrint assay does not have clinical utility in such patients. If a patient has hormone receptor-positive, HER2-negative, node-positive breast cancer, the MammaPrint assay may be used in patients with one to three positive nodes and a high clinical risk to inform decisions on withholding adjuvant systemic chemotherapy. However, such patients should be informed that a benefit from chemotherapy cannot be excluded, particularly in patients with greater than one involved lymph node. The clinician should not use the MammaPrint assay to guide decisions on adjuvant systemic therapy in patients with hormone receptor-positive, HER2-negative, node-positive breast cancer at low clinical risk, nor any patient with HER2-positive or triple-negative breast cancer, because of the lack of definitive data in these populations. Additional information can be found at www.asco.org/breast-cancer-guidelines and www.asco.org/guidelineswiki .

14 Guideline Practice Bulletin Number 179: Breast Cancer Risk Assessment and Screening in Average-Risk Women. 2017

Anonymous2451093. · ·Obstet Gynecol · Pubmed #28644335.

ABSTRACT: Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4).Breast cancer risk assessment is very important for identifying women who may benefit from more intensive breast cancer surveillance; however, there is no standardized approach to office-based breast cancer risk assessment in the United States. This can lead to missed opportunities to identify women at high risk of breast cancer and may result in applying average-risk screening recommendations to high-risk women. Risk assessment and identification of women at high risk allow for referral to health care providers with expertise in cancer genetics counseling and testing for breast cancer-related germline mutations (eg, BRCA), patient counseling about risk-reduction options, and cascade testing to identify family members who also may be at increased risk.The purpose of this Practice Bulletin is to discuss breast cancer risk assessment, review breast cancer screening guidelines in average-risk women, and outline some of the controversies surrounding breast cancer screening. It will present recommendations for using a framework of shared decision making to assist women in balancing their personal values regarding benefits and harms of screening at various ages and intervals to make personal screening choices from within a range of reasonable options. Recommendations for women at elevated risk and discussion of new technologies, such as tomosynthesis, are beyond the scope of this document and are addressed in other publications of the American College of Obstetricians and Gynecologists (ACOG) (5-7).

15 Guideline Practice Bulletin No. 179 Summary: Breast Cancer Risk Assessment and Screening in Average-Risk Women. 2017

Anonymous291200. · ·Obstet Gynecol · Pubmed #28644328.

ABSTRACT: Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women (1). Regular screening mammography starting at age 40 years reduces breast cancer mortality in average-risk women (2). Screening, however, also exposes women to harm through false-positive test results and overdiagnosis of biologically indolent lesions. Differences in balancing benefits and harms have led to differences among major guidelines about what age to start, what age to stop, and how frequently to recommend mammography screening in average-risk women (2-4).Breast cancer risk assessment is very important for identifying women who may benefit from more intensive breast cancer surveillance; however, there is no standardized approach to office-based breast cancer risk assessment in the United States. This can lead to missed opportunities to identify women at high risk of breast cancer and may result in applying average-risk screening recommendations to high-risk women. Risk assessment and identification of women at high risk allow for referral to health care providers with expertise in cancer genetics counseling and testing for breast cancer-related germline mutations (eg, BRCA), patient counseling about risk-reduction options, and cascade testing to identify family members who also may be at increased risk.The purpose of this Practice Bulletin is to discuss breast cancer risk assessment, review breast cancer screening guidelines in average-risk women, and outline some of the controversies surrounding breast cancer screening. It will present recommendations for using a framework of shared decision making to assist women in balancing their personal values regarding benefits and harms of screening at various ages and intervals to make personal screening choices from within a range of reasonable options. Recommendations for women at elevated risk and discussion of new technologies, such as tomosynthesis, are beyond the scope of this document and are addressed in other publications of the American College of Obstetricians and Gynecologists (ACOG) (5-7).

16 Guideline Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: A Cancer Care Ontario and American Society of Clinical Oncology Clinical Practice Guideline. 2017

Dhesy-Thind, Sukhbinder / Fletcher, Glenn G / Blanchette, Phillip S / Clemons, Mark J / Dillmon, Melissa S / Frank, Elizabeth S / Gandhi, Sonal / Gupta, Rasna / Mates, Mihaela / Moy, Beverly / Vandenberg, Ted / Van Poznak, Catherine H. ·Sukhbinder Dhesy-Thind, Juravinski Cancer Centre; Sukhbinder Dhesy-Thind and Glenn G. Fletcher, McMaster University, Hamilton, Ontario; Phillip S. Blanchette, Sunnybrook Odette Cancer Centre; Sonal Gandhi, Sunnybrook Health Sciences, Toronto, Ontario; Mark J. Clemons, The Ottawa Hospital Cancer Centre, Ottawa, Ontario; Rasna Gupta, Windsor Regional Cancer Program, Windsor, Ontario; Mihaela Mates, Kingston General Hospital, Kingston, Ontario; Ted Vandenberg, London Health Sciences Centre, London, Ontario, Canada; Melissa S. Dillmon, Harbin Clinic, Rome, GA; Elizabeth S. Frank, Lexington; Beverly Moy, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; and Catherine H. Van Poznak, University of Michigan, Ann Arbor, MI. ·J Clin Oncol · Pubmed #28618241.

ABSTRACT: Purpose To make recommendations regarding the use of bisphosphonates and other bone-modifying agents as adjuvant therapy for patients with breast cancer. Methods Cancer Care Ontario and ASCO convened a Working Group and Expert Panel to develop evidence-based recommendations informed by a systematic review of the literature. Results Adjuvant bisphosphonates were found to reduce bone recurrence and improve survival in postmenopausal patients with nonmetastatic breast cancer. In this guideline, postmenopausal includes patients with natural menopause or that induced by ovarian suppression or ablation. Absolute benefit is greater in patients who are at higher risk of recurrence, and almost all trials were conducted in patients who also received systemic therapy. Most studies evaluated zoledronic acid or clodronate, and data are extremely limited for other bisphosphonates. While denosumab was found to reduce fractures, long-term survival data are still required. Recommendations It is recommended that, if available, zoledronic acid (4 mg intravenously every 6 months) or clodronate (1,600 mg/d orally) be considered as adjuvant therapy for postmenopausal patients with breast cancer who are deemed candidates for adjuvant systemic therapy. Further research comparing different bone-modifying agents, doses, dosing intervals, and durations is required. Risk factors for osteonecrosis of the jaw and renal impairment should be assessed, and any pending dental or oral health problems should be dealt with prior to starting treatment. Data for adjuvant denosumab look promising but are currently insufficient to make any recommendation. Use of these agents to reduce fragility fractures in patients with low bone mineral density is beyond the scope of the guideline. Recommendations are not meant to restrict such use of bone-modifying agents in these situations. Additional information at www.asco.org/breast-cancer-adjuvant-bisphosphonates-guideline , www.asco.org/guidelineswiki , https://www.cancercareontario.ca/guidelines-advice/types-of-cancer/breast .

17 Guideline First international consensus conference on standardization of oncoplastic breast conserving surgery. 2017

Weber, Walter P / Soysal, Savas D / El-Tamer, Mahmoud / Sacchini, Virgilio / Knauer, Michael / Tausch, Christoph / Hauser, Nik / Günthert, Andreas / Harder, Yves / Kappos, Elisabeth A / Schwab, Fabienne / Fitzal, Florian / Dubsky, Peter / Bjelic-Radisic, Vesna / Reitsamer, Roland / Koller, Rupert / Heil, Jörg / Hahn, Markus / Blohmer, Jens-Uwe / Hoffmann, Jürgen / Solbach, Christine / Heitmann, Christoph / Gerber, Bernd / Haug, Martin / Kurzeder, Christian. ·Breast Center, University Hospital Basel, Basel, Switzerland. walter.weber@usb.ch. · Breast Center, University Hospital Basel, Basel, Switzerland. · Memorial Sloan Kettering Cancer Center, New York, USA. · Breast Center St. Gallen, St. Gallen, Switzerland. · Breast-Center Zurich, Zurich, Switzerland. · Breast Center Hirslanden Clinics Aarau Cham Zug and frauenarztzentrum aargau ag, Baden, Switzerland. · Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland. · Division of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano (ORL), Breast Centre of Switzerland (CSSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland. · Department of Surgery and Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria. · Breast Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland. · Department of Gynecology, Medical Univerisity Graz, Auenbruggerplatz 14, 8036, Graz, Austria. · Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria. · Plastische, Ästhetische und Rekonstruktive Chirurgie, Wilhelminenspital der Stadt, Vienna, Austria. · Universitäts-Brustzentrum, Universitäts-Frauenklinik, Im Neuenheimer Feld 440, Heidelberg, Germany. · Department of Women's Health, University Breast Center Tubingen, Tübingen, Germany. · Gynecology with Breast Center, Charité Universitätsmedizin Berlin, Berlin, Germany. · Breast Center, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany. · Breast Center, University Hospital Frankfurt, Frankfurt, Germany. · Breast Center at the English Garden, Munich, Germany. · Breast Surgery Unit at the Department of Ob/Gyn, University Hospital Rostock, Suedring 81, 18059, Rostock, Germany. ·Breast Cancer Res Treat · Pubmed #28578506.

ABSTRACT: PURPOSE: To obtain consensus recommendations for the standardization of oncoplastic breast conserving surgery (OPS) from an international panel of experts in breast surgery including delegates from the German, Austrian and Swiss societies of senology. METHODS: A total of 52 questions were addressed by electronic voting. The panel's recommendations were put into context with current evidence and the report was circled in an iterative open email process until consensus was obtained. RESULTS: The panelists considered OPS safe and effective for improving aesthetic outcomes and broadening the indication for breast conserving surgery (BCS) towards larger tumors. A slim majority believed that OPS reduces the rate of positive margins; however, there was consensus that OPS is associated with an increased risk of complications compared to conventional BCS. The panel strongly endorsed patient-reported outcomes measurement, and recommended selected scales of the Breast-Q™-Breast Conserving Therapy Module for that purpose. The Clough bi-level classification was recommended for standard use in clinical practice for indicating, planning and performing OPS, and the Hoffmann classification for surgical reports and billing purposes. Mastopexy and reduction mammoplasty were the only two recognized OPS procedure categories supported by a majority of the panel. Finally, the experts unanimously supported the statement that every OPS procedure should be tailored to each individual patient. CONCLUSIONS: When implemented into clinical practice, the panel recommendations may improve safety and effectiveness of OPS. The attendees agreed that there is a need for prospective multicenter studies to optimize patient selection and for standardized criteria to qualify and accredit OPS training centers.

18 Guideline Digital breast tomosynthesis (DBT): recommendations from the Italian College of Breast Radiologists (ICBR) by the Italian Society of Medical Radiology (SIRM) and the Italian Group for Mammography Screening (GISMa). 2017

Bernardi, Daniela / Belli, Paolo / Benelli, Eva / Brancato, Beniamino / Bucchi, Lauro / Calabrese, Massimo / Carbonaro, Luca A / Caumo, Francesca / Cavallo-Marincola, Beatrice / Clauser, Paola / Fedato, Chiara / Frigerio, Alfonso / Galli, Vania / Giordano, Livia / Giorgi Rossi, Paolo / Golinelli, Paola / Morrone, Doralba / Mariscotti, Giovanna / Martincich, Laura / Montemezzi, Stefania / Naldoni, Carlo / Paduos, Adriana / Panizza, Pietro / Pediconi, Federica / Querci, Fiammetta / Rizzo, Antonio / Saguatti, Gianni / Tagliafico, Alberto / Trimboli, Rubina M / Zappa, Marco / Zuiani, Chiara / Sardanelli, Francesco. ·U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiologia, APSS, Centro per i Servizi Sanitari, Pal. C, viale Verona, 38123, Trento, Italy. · Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy. · Zadig Scientific Communication Agency, Via Arezzo 21, 00161, Rome, Italy. · Struttura Complessa di Senologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Via Cosimo il Vecchio 2, 50139, Florence, Italy. · Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Via Piero Maroncelli 40, Meldola, 47014, Forlì, Italy. · UOC Senologia Diagnostica, IRCCS AOU San Martino-IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy. · Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy. · UOSD Breast Unit ULSS 20, Piazza Lambranzi 1, 37142, Verona, Italy. · Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto I, Sapienza Università di Roma, Viale Regina Elena 324, 00161, Rome, Italy. · Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna/General Hospital Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. · Regional Screening Coordinating Centre, Veneto Region, Venice, Italy. · Regional Reference Centre for Breast Cancer Screening, Turin, Italy. · Mammography Screening Centre, Local Health Authority, Modena, Italy. · Epidemiology Unit, Centre for Cancer Prevention, Turin, Italy. · Interinstitutional Epidemiology Unit, AUSL Reggio Emilia, and Arcispedale S. Maria Nuova, Reggio Emilia, Italy. · Medical Physics Service, Local Health Authority, Modena, Italy. · Radiologia 1U, Dipartimento di Diagnostica per Immagini, Università di Torino, A. O. U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy. · U.O. Radiodiagnostica, Candiolo Cancer Institute, FPO, IRCCS, Strada Provinciale 142, km 3.95, Candiolo, 10060, Turin, Italy. · DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy. · Department of Health, Emilia-Romagna Region, Bologna, Italy. · U.O. Radiologia Senologica, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy. · Department of Prevention, Screening Centre, Local Health Authority, Sassari, Italy. · Pathology Department, Local Health Authority, Asolo, Treviso, Italy. · Senology Unit, Local Health Authority, Bologna, Italy. · Department of Experimental Medicine, DIMES, Institute of Anatomy, University of Genova, Via de Toni 14, 16132, Genoa, Italy. · Department of Biomedical Science for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy. · UOC Epidemiologia Clinica, Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy. · Institute of Radiology, University of Udine, Piazzale S. M. della Misericordia 15, 33100, Udine, Italy. · Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy. francesco.sardanelli@unimi.it. · Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy. francesco.sardanelli@unimi.it. ·Radiol Med · Pubmed #28540564.

ABSTRACT: This position paper, issued by ICBR/SIRM and GISMa, summarizes the evidence on DBT and provides recommendations for its use. In the screening setting, DBT in adjunct to digital mammography (DM) increased detection rate by 0.5-2.7‰ and decreased false positives by 0.8-3.6% compared to DM alone in observational and double-testing experimental studies. The reduction in recall rate could be less prominent in those screening programs which already have low recall rates with DM. The increase in radiation exposure associated with DM/DBT protocols has been solved by the introduction of synthetic mammograms (sDM) reconstructed from DBT datasets. Thus, whenever possible, sDM/DBT should be preferred to DM/DBT. However, before introducing DBT as a routine screening tool for average-risk women, we should wait for the results of randomized controlled trials and for a statistically significant and clinically relevant reduction in the interval cancer rate, hopefully associated with a reduction in the advanced cancer rate. Otherwise, a potential for overdiagnosis and overtreatment cannot be excluded. Studies exploring this issue are ongoing. Screening of women at intermediate risk should follow the same recommendations, with particular protocols for women with previous BC history. In high-risk women, if mammography is performed as an adjunct to MRI or in the case of MRI contraindications, sDM/DBT protocols are suggested. Evidence exists in favor of DBT usage in women with clinical symptoms/signs and asymptomatic women with screen-detected findings recalled for work-up. The possibility to perform needle biopsy or localization under DBT guidance should be offered when DBT-only findings need characterization or surgery.

19 Guideline NCCN Guidelines Update: Evolving Radiation Therapy Recommendations for Breast Cancer. 2017

Salerno, Kilian E. ·Presented by Kilian E. Salerno, MD, Breast Radiation and Soft Tissue/Melanoma Radiation, Roswell Park Cancer Institute. ·J Natl Compr Canc Netw · Pubmed #28515243.

ABSTRACT: In the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer, among adjuvant radiotherapy options for whole-breast irradiation after breast-conserving surgery, hypofractionation is preferred. For the use of accelerated partial-breast irradiation, the NCCN Guidelines have adopted the updated definition of "suitability" used by the American Society for Radiation Oncology. Regional nodal irradiation is indicated-either in the setting of breast-conserving surgery or after mastectomy-for women with ≥4 positive nodes and should be strongly considered for 1 to 3 positive lymph nodes and select patients with node-negative disease deemed at high risk for recurrence.

20 Guideline ACR Appropriateness Criteria 2017

Anonymous3171079 / Moy, Linda / Bailey, Lisa / D'Orsi, Carl / Green, Edward D / Holbrook, Anna I / Lee, Su-Ju / Lourenco, Ana P / Mainiero, Martha B / Sepulveda, Karla A / Slanetz, Priscilla J / Trikha, Sunita / Yepes, Monica M / Newell, Mary S. ·Principal Author, NYU Clinical Cancer Center, New York, New York. Electronic address: linda.moy@nyumc.org. · Bay Area Breast Surgeons, Emeryville, California; American College of Surgeons. · Emory University Hospital, Atlanta, Georgia. · The University of Mississippi Medical Center, Jackson, Mississippi. · University of Cincinnati, Cincinnati, Ohio. · Rhode Island Hospital, Providence, Rhode Island. · Baylor College of Medicine, Houston, Texas. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · North Shore University Hospital, Manhasset, New York. · University of Miami, Miami, Florida. · Panel Chair, Emory University Hospital, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #28473085.

ABSTRACT: Women and health care professionals generally prefer intensive follow-up after a diagnosis of breast cancer. However, there are no survival differences between women who obtain intensive surveillance with imaging and laboratory studies compared with women who only undergo testing because of the development of symptoms or findings on clinical examinations. American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines state that annual mammography is the only imaging examination that should be performed to detect a localized breast recurrence in asymptomatic patients; more imaging may be needed if the patient has locoregional symptoms (eg, palpable abnormality). Women with other risk factors that increase their lifetime risk for breast cancer may warrant evaluation with breast MRI. Furthermore, the quality of life is similar for women who undergo intensive surveillance compared with those who do not. There is little justification for imaging to detect or rule out metastasis in asymptomatic women with newly diagnosed stage I breast cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

21 Guideline ACR Appropriateness Criteria 2017

Anonymous3131079 / Jokich, Peter M / Bailey, Lisa / D'Orsi, Carl / Green, Edward D / Holbrook, Anna I / Lee, Su-Ju / Lourenco, Ana P / Mainiero, Martha B / Moy, Linda / Sepulveda, Karla A / Slanetz, Priscilla J / Trikha, Sunita / Yepes, Monica M / Newell, Mary S. ·Principal Author, Rush Breast Imaging Center, Chicago, Illinois. Electronic address: peter_jokich@rush.edu. · Bay Area Breast Surgeons, Emeryville, California; American College of Surgeons. · Emory University Hospital, Atlanta, Georgia. · University of Mississippi Medical Center, Jackson, Mississippi. · University of Cincinnati, Cincinnati, Ohio. · Rhode Island Hospital, Providence, Rhode Island. · NYU Clinical Cancer Center, New York, New York. · Baylor College of Medicine, Houston, Texas. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · North Shore University Hospital, Manhasset, New York. · University of Miami, Miami, Florida. · Panel Chair, Emory University Hospital, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #28473081.

ABSTRACT: Breast pain (or tenderness) is a common symptom, experienced by up to 80% of women at some point in their lives. Fortunately, it is rarely associated with breast cancer. However, breast pain remains a common cause of referral for diagnostic breast imaging evaluation. Appropriate workup depends on the nature and focality of the pain, as well as the age of the patient. Imaging evaluation is usually not indicated if the pain is cyclic or nonfocal. For focal, noncyclic pain, imaging may be appropriate, mainly for reassurance and to identify treatable causes. Ultrasound can be the initial examination used to evaluate women under 30 with focal, noncyclic breast pain; for women 30 and older, diagnostic mammography, digital breast tomosynthesis, and ultrasound may all serve as appropriate initial examinations. However, even in the setting of focal, noncyclic pain, cancer as an etiology is rare. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

22 Guideline ACR Appropriateness Criteria 2017

Anonymous3091079 / Moy, Linda / Heller, Samantha L / Bailey, Lisa / D'Orsi, Carl / DiFlorio, Roberta M / Green, Edward D / Holbrook, Anna I / Lee, Su-Ju / Lourenco, Ana P / Mainiero, Martha B / Sepulveda, Karla A / Slanetz, Priscilla J / Trikha, Sunita / Yepes, Monica M / Newell, Mary S. ·Principal Author and Panel Vice-Chair, NYU Clinical Cancer Center, New York, New York. Electronic address: linda.moy@nyumc.org. · Research Author, New York University School of Medicine, New York, New York. · Bay Area Breast Surgeons, Emeryville, California; American College of Surgeons. · Emory University Hospital, Atlanta, Georgia. · Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. · The University of Mississippi Medical Center, Jackson, Mississippi. · University of Cincinnati, Cincinnati, Ohio. · Rhode Island Hospital, Providence, Rhode Island. · Baylor College of Medicine, Houston, Texas. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Northwell Health, Syosset, New York. · University of Miami, Miami, Florida. · Panel Chair, Emory University Hospital, Atlanta, Georgia. ·J Am Coll Radiol · Pubmed #28473077.

ABSTRACT: Breast cancer is the most common female malignancy and the second leading cause of female cancer death in the United States. Although the majority of palpable breast lumps are benign, a new palpable breast mass is a common presenting sign of breast cancer. Any woman presenting with a palpable lesion should have a thorough clinical breast examination, but because many breast masses may not exhibit distinctive physical findings, imaging evaluation is necessary in almost all cases to characterize the palpable lesion. Recommended imaging options in the context of a palpable mass include diagnostic mammography and targeted-breast ultrasound and are dependent on patient age and degree of radiologic suspicion as detailed in the document Variants. There is little role for advanced technologies such as MRI, positron emission mammography, or molecular breast imaging in the evaluation of a palpable mass. When a suspicious finding is identified, biopsy is indicated. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

23 Guideline Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. 2017

Greenlee, Heather / DuPont-Reyes, Melissa J / Balneaves, Lynda G / Carlson, Linda E / Cohen, Misha R / Deng, Gary / Johnson, Jillian A / Mumber, Matthew / Seely, Dugald / Zick, Suzanna M / Boyce, Lindsay M / Tripathy, Debu. ·Assistant Professor, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. · Member, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY. · Doctoral Fellow, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. · Associate Professor, College of Nursing, Rady Faculty of Health Sciences, Winnipeg, MB, Canada. · Professor, Department of Oncology, University of Calgary, Calgary, AB, Canada. · Adjunct Professor, American College of Traditional Chinese Medicine at California Institute of Integral Studies, San Francisco, CA. · Clinic Director, Chicken Soup Chinese Medicine, San Francisco, CA. · Medical Director, Integrative Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. · Post-Doctoral Scholar, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA. · Radiation Oncologist, Harbin Clinic, Rome, GA. · Executive Director, Ottawa Integrative Cancer Center, Ottawa, ON, Canada. · Executive Director of Research, Canadian College of Naturopathic Medicine, Toronto, ON, Canada. · Research Associate Professor, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI. · Research Associate Professor, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI. · Research Informationist, Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, NY. · Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. ·CA Cancer J Clin · Pubmed #28436999.

ABSTRACT: Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society.

24 Guideline NCCN Guidelines Insights: Breast Cancer, Version 1.2017. 2017

Gradishar, William J / Anderson, Benjamin O / Balassanian, Ron / Blair, Sarah L / Burstein, Harold J / Cyr, Amy / Elias, Anthony D / Farrar, William B / Forero, Andres / Giordano, Sharon Hermes / Goetz, Matthew P / Goldstein, Lori J / Isakoff, Steven J / Lyons, Janice / Marcom, P Kelly / Mayer, Ingrid A / McCormick, Beryl / Moran, Meena S / O'Regan, Ruth M / Patel, Sameer A / Pierce, Lori J / Reed, Elizabeth C / Salerno, Kilian E / Schwartzberg, Lee S / Sitapati, Amy / Smith, Karen Lisa / Smith, Mary Lou / Soliman, Hatem / Somlo, George / Telli, Melinda / Ward, John H / Shead, Dorothy A / Kumar, Rashmi. ·From Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; UCSF Helen Diller Family Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; University of Alabama at Birmingham Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Mayo Clinic Cancer Center; Fox Chase Cancer Center; Massachusetts General Hospital Cancer Center; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; Duke Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan Kettering Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; University of Wisconsin Carbone Cancer Center; University of Michigan Comprehensive Cancer Center; Fred & Pamela Buffett Cancer Center; Roswell Park Cancer Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Research Advocacy Network; Moffitt Cancer Center; City of Hope Comprehensive Cancer Center; Stanford Cancer Institute; Huntsman Cancer Institute at the University of Utah; and National Comprehensive Cancer Network. ·J Natl Compr Canc Netw · Pubmed #28404755.

ABSTRACT: These NCCN Guidelines Insights highlight the important updates/changes to the surgical axillary staging, radiation therapy, and systemic therapy recommendations for hormone receptor-positive disease in the 1.2017 version of the NCCN Guidelines for Breast Cancer. This report summarizes these updates and discusses the rationale behind them. Updates on new drug approvals, not available at press time, can be found in the most recent version of these guidelines at NCCN.org.

25 Guideline NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma. 2017

Clemens, Mark W / Horwitz, Steven M. ·Associate Professor, Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX, USA. · Attending Medical Oncologist of Lymphoma, Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. ·Aesthet Surg J · Pubmed #28184418.

ABSTRACT: Published case series demonstrate a lack of treatment standardization for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) with a wide variety of therapeutic strategies being employed at all stages of disease. The National Comprehensive Cancer Network (NCCN) annually publishes Clinical Practice Guidelines for Non-Hodgkin Lymphomas. For the first time, BIA-ALCL management will be included which signifies an important and needed guideline addition. The new BIA-ALCL guideline was achieved by a consensus of lymphoma oncologists, plastic surgeons, radiation oncologists, and surgical oncologists. NCCN guidelines focus on the diagnosis and management throughout the stages of many lymphoma subtypes based upon the most current data available. This article summarizes the essential recommendations and optimal therapeutic strategies of the NCCN guidelines critical to the plastic surgery community. We encourage international adoption of these BIA-ALCL treatment standards by our specialty societies across the oncology and surgery disciplines.

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