The National Institute for Health and Clinical Excellence has published two sets of guidelines for the diagnosis and treatment of patients with early and advanced breast cancer, to help services become less fragmented and reduce care inequalities across the country.

The new guidelines for best practice in breast cancer have been constructed to provide a “systematic framework” of support to patients, the Institute says, and it is hoped that they will help to equalise access to care and related services.

Every year in England and Wales there are around 40,500 new cases of breast cancer and 10,900 lives are lost because of the disease, which is the most common type of cancer in women, highlighting the importance of setting a high standard of care across England and Wales.

Only a relatively small proportion of cases are diagnosed as being advanced, but there is no cure and so treatment is largely focused on managing the disease and providing relief for any associated symptoms.

In its guidance, NICE recommends that patients with ER (oestrogen receptor)-positive advanced breast cancer are offered treatment with an endocrine therapy as a first-line treatment.

NICE also stresses that therapy with Roche/Genentech’s Herceptin (trastuzumab) should only be continued in patients with advanced breast cancer while disease progression stays within the central nervous system, and that it should be discontinued when the cancer spreads beyond it.

With regard to managing disease complications, the Institute insists that a “multidisciplinary team” of breast cancer specialists assess each patient and discuss with them treatment options for controlling the disease and relieving any related symptoms. For example, it advises doctors to consider offering patients in whom the cancer has spread to the bone a bisphosphonate to prevent skeletal damage and lessen pain.

Treatment for early breast cancer
For patients with early invasive breast cancer, in which treatment is focused on tumour removal and preventing the cancer from spreading, the Institute makes several recommendations with regard to medication.

For example, the aromatase inhibitors anastrozole or letrozole are recommended for treatment of post-menopausal women with ER-positive early breast cancer as initial adjuvant therapy to surgery, while an endocrine therapy plus tamoxifen should only be offered to pre-menopausal patients if they have declined treatment with a chemotherapy.

Both sets of guidance stress the importance of good communication and the provision of “evidence-based information” to enable patients to make informed decisions about their treatment, as well as offering support on an emotional and physical level to encourage a more holistic approach to care.