Practice 1
Appropriate to offer genetic counselling to women with a high familial risk at or around the time that they are diagnosed with breast cancer, with a view to genetic testing to inform decision-making about treatment.
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Practice 2
Appropriate to ensure optimal fixation of breast cancer specimens for accurate pathological examination and biomarker assessment.
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Practice 3
Appropriate to consider and discuss fertility and family planning with premenopausal women before they undergo breast cancer treatment.
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Practice 4
Appropriate to offer a choice of either breast conserving surgery followed by radiotherapy, or a mastectomy to patients diagnosed with early breast cancer, as these treatments are equally effective in terms of survival.
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Practice 5
Appropriate to offer a shorter, more intense course of radiotherapy (hypofractionated radiotherapy) as an alternative to conventional radiotherapy for patients with early breast cancer who:
- are aged 50 years and over;
- have a cancer at an early pathological stage (T1-2, N0, M0); and
- have undergone breast conserving surgery with clear surgical margins.
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Practice 6
Appropriate to offer patients with early breast cancer the opportunity for their follow-up care to be shared between a primary care physician and a specialist, to provide more accessible, whole-person care.
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Practice 7
Appropriate to offer palliative care early in the management of patients with symptomatic, metastatic breast cancer to improve symptom control and quality of life.
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Practice 8
Appropriate to consider the pre-operative use of chemotherapy or hormonal therapy (systemic, neoadjuvant therapy) informed by hormone and HER2 receptor status, for all patients where these therapies are clinically indicated.
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Practice 9
Not appropriate to confirm or exclude a diagnosis of breast cancer without undertaking the triple test, which involves:
- taking a patient history and clinical breast examination;
- imaging tests (mammogram and/or ultrasound); and
- biopsy to remove cells or tissue for examination.
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Practice 10
Not appropriate to offer a sentinel node biopsy to patients diagnosed with DCIS (ductal carcinoma in situ) having breast conserving surgery, unless clinically indicated.
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Practice 11
Not appropriate to perform a mastectomy without first discussing with the patient the options of immediate or delayed breast reconstruction.
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Practice 12
Not appropriate to perform intensive testing (full blood count, biochemistry or tumour markers) or imaging (chest X-ray, PET, CT and radionuclide bone scans) as part of standard follow-up of patients who have been treated for early breast cancer and who are not experiencing symptoms.