People with early invasive breast cancer should have minimal surgery without removal of lymph nodes unless there is evidence that cancer has spread to them, recommends new guidance for the NHS in England and Wales.

It also suggests that women who are being advised to have a mastectomy should be offered breast reconstruction, even if it is not available locally, and it updates recommendations on choice of hormonal therapy, on the basis of the latest research.

The new guidance on early breast cancer from the National Institute for Health and Clinical Excellence (NICE) advises against lymph node clearance in people in whom no evidence is shown on ultrasonography or needle biopsy of lymph node involvement. It suggests that sentinel lymph node biopsy should be used to assess whether …