Practice Guidelines

Diagnosis and treatment of advanced breast cancer: summary of NICE guidance

BMJ 2009; 338 doi: (Published 25 February 2009) Cite this as: BMJ 2009;338:b509
  1. N Murray, senior lecturer and honorary consultant1,
  2. J Winstanley, consultant surgeon2,
  3. A Bennett, assistant centre manager3,
  4. K Francis, researcher3
  5. on behalf of the Guideline Development Group
  1. 1Cancer Research UK Clinical Centre, University of Southampton, Somers Cancer Research Building, Southampton General Hospital, Southampton SO16 6YD
  2. 2Royal Bolton Hospital, Bolton BL4 0RJ
  3. 3National Collaborating Centre for Cancer, Cardiff CF10 3AF
  1. Correspondence to: N Murray nickm{at}

    Why read this summary?

    Breast cancer is the most common cancer in women and the second most common cause of death from cancer in women in the United Kingdom. Each year in the UK more than 12 300 women and 70 men will die from advanced breast cancer having lived with this condition for an average of two to three years before death.1 2 3 4 Management of advanced breast cancer requires the input of a wide range of healthcare professionals, usually in primary, secondary, and tertiary healthcare settings. Clinical practice and availability of certain treatments and procedures are known to vary across the UK. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and treatment of advanced breast cancer.5


    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.

    Diagnosis and assessment

    Imaging assessment

    • Assess the presence and extent of metastases in the bones of the axial skeleton using bone windows on a computed tomography (CT) scan or magnetic resonance imaging (MRI) or using bone scintigraphy.

    • Assess proximal limb bones for the risk of pathological fracture in patients with evidence of bone metastases elsewhere, using bone scintigraphy and/or plain radiography. [Based on evidence from small comparative studies or case series and on the opinion of the Guideline Development Group]

    • Use MRI to assess bony metastases if other imaging is equivocal for metastatic disease or if more information is needed (for example, if lytic metastases are encroaching on the spinal canal).

    • Positron emission tomography fused with computed tomography (PET-CT) should be used to make a new diagnosis of metastases only for patients with …

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