Intended for healthcare professionals

Practice Guidelines

Diagnosis and treatment of early breast cancer, including locally advanced disease—summary of NICE guidance

BMJ 2009; 338 doi: (Published 25 February 2009) Cite this as: BMJ 2009;338:b438
  1. Adrian Harnett, consultant clinical oncologist 1,
  2. James Smallwood, consultant surgeon2,
  3. Victoria Titshall, project manager3,
  4. Andrew Champion, centre manager3
  5. on behalf of the Guideline Development Group
  1. 1Norfolk and Norwich University Hospital, Norwich NR4 7UY
  2. 2Southampton University Hospital NHS Trust, Southampton SO16 6YD
  3. 3National Collaborating Centre for Cancer, Cardiff CF10 3AF
  1. Correspondence to: A Harnett adrian.harnett{at}

    Why read this summary?

    Breast cancer is the commonest cancer in women, with over 40 500 new cases diagnosed each year in England and Wales.1 2 Despite a steady decline in age standardised mortality rates owing to screening and better management, the disease still causes 10 900 deaths each year in England and Wales,1 2 with a huge social and emotional impact. This article outlines the most important recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and treatment of early and locally advanced breast cancer.3


    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    This new guideline covers women presenting with breast cancer in whom the primary tumour may have been non-palpable and detected by screening mammography through to women with cancers over 5 cm but in whom there is no evidence of spread beyond the breast and axillary lymph nodes. The guideline includes a large spectrum of disease, ranging from ductal carcinoma in situ (DCIS) to inflammatory breast cancer, and also includes breast cancer in men, which is rare. Advanced breast cancer is the subject of another guideline.4

    Diagnosis and preoperative assessment

    • Magnetic resonance imaging (MRI) of the breast is not recommended as a routine preoperative assessment of patients with invasive breast cancer or DCIS but can help when a discrepancy exists between the clinical and radiological assessment, when breast density prevents mammographic assessment, or when breast conservation surgery to assess tumour size is being considered in lobular cancer. [Based on moderate quality evidence from case-control and case series studies and on the experience of the Guideline Development Group]

    • Ensure that pretreatment ultrasonography …

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