Cancer Guidelines Database

Access quality cancer guidelines from a single Canadian source

We've listed 104 guidelines under your selection of "Type of cancer". The most recent guidelines are first.

ACR Appropriateness Criteria Imaging after Mastectomy and Breast Reconstruction

Year: 2020
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for women who have undergone mastectomy, with or without breast reconstruction, due to a high risk of breast cancer, including those previously treated for the disease. The guideline examines the appropriateness of imaging modalities for the screening and diagnosis of breast cancer in these patients. Specific procedures discussed include fluorine-18-2-fluoro-2-deoxy-D-glucose-positron emission mammography (FDG-PEM), digital breast tomosynthesis (DBT), mammography, magnetic resonance imaging (MRI) with or without intravenous (IV) contrast, Tc-99m sestamibi molecular breast imaging (MBI), and ultrasound.

Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update

Year: 2020
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for patients with breast cancer. The guideline examines the use of estrogen and progesterone receptor testing to determine which patients are best suited for endocrine therapy. Specific topics addressed include the prognostic value of estrogen and progesterone receptors, testing of ductal carcinoma in situ, and other potential assays for determining patient suitability for endocrine therapy.

Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline

Year: 2020
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for adults with early or advanced stage breast cancer who carry germline mutations in breast cancer susceptibility genes. The guideline discusses the management of these patients, including surgical management of the index malignancy, therapeutic mastectomy, nipple-sparing mastectomy, contralateral prophylactic mastectomy, contralateral risk-reducing mastectomy, radiation therapy, platinum chemotherapy, and neoadjuvant platinum chemotherapy. The increased risk of contralateral breast cancer and new ipsilateral breast cancer in these patients is specifically highlighted.

Management of Male Breast Cancer: ASCO Guideline

Year: 2020
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for men who have been diagnosed with invasive breast cancer. The guideline examines management strategies for these patients. Specific topics discussed include adjuvant endocrine therapy, targeted therapies, management of treatment-related adverse effects, genetic testing, and post-treatment surveillance.

International Multidisciplinary Expert Panel Consensus on Breast Reconstruction and Radiotherapy

Year: 2019
AGREE II score: Unavailable
Developer organization:
This is a clinical practice guideline for women undergoing mastectomy for the treatment of breast cancer. The guideline examines breast reconstruction in these patients, and the impact of radiotherapy. The timing of breast reconstruction, implant-based versus autologous tissue-based reconstruction, and decision-making in the context of radiotherapy are specifically discussed.

Baseline Staging Imaging for Distant Metastasis in Women With Stage I, II, and III Breast Cancer

Year: 2019
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for women with newly diagnosed stage I, II, and III breast cancer who have no symptoms of distant metastasis. The guideline examines the use of imaging tests to detect distant metastases in these patients. Anatomic imaging modalities (e.g. chest x-ray, liver ultrasound, chest-abdomen-pelvis CT scan) and metabolic imaging modalities (e.g. PET/CT, PET/MR, bone scintigraphy) are specifically discussed.

Medication Use to Reduce Risk of Breast Cancer US Preventive Services Task Force Recommendation Statement

Year: 2019
AGREE II score: Available
Developer organization: United States Preventive Services Task Force
This is a clinical practice guideline for reducing the risk of breast cancer. The guideline examines the use of potential risk-reducing medications such as tamoxifen, raloxifene, or aromatase inhibitors in asymptomatic women over 35 years of age, including women with previous benign breast lesions identified via biopsy. Outcomes of interest include breast cancer risk-reduction, and adverse effects from preventive medications.

Use of Endocrine Therapy for Breast Cancer Risk Reduction: ASCO Clinical Practice Guideline Update

Year: 2019
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline on breast cancer in adult patients. The guideline examines endocrine therapy as a risk-reduction intervention in patients who are at increased risk of developing the disease but have not been previously diagnosed. Various interventions are examined while taking into consideration pre-menopausal versus post-menopausal patients' needs. The primary outcomes of interest are the incidences of invasive and non-invasive breast cancer.

Adjuvant Bisphosphonate Therapy in Primary Breast Cancer

Year: 2019
AGREE II score: Unavailable
Developer organization: Eastern Health
This is a clinical practice guideline for women with early stage breast cancer. The guideline examines the use of adjuvant bisphosphonate therapy in these patients. The appropriate choice of bisphosphonates and patient eligibility criteria are discussed. Menopausal status is also specifically addressed.

Breast Cancer

Year: 2019
AGREE II score: Unavailable
Developer organization: BC Cancer Agency
This is a guideline for the prevention, screening/early detection, diagnosis, staging, and management of breast cancer. Management options for early invasive breast cancer, stage I or II tumours, locally advanced breast cancer, inflammatory breast cancer, locoregional recurrence, metastatic breast cancer and special circumstances in breast cancer patients are discussed. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.

ACR Appropriateness Criteria Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women

Year: 2019
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for women with Stage I breast cancer. The guideline examines the appropriateness of various imaging techniques during the management of these patients. Specific clinical situations addressed include the initial imaging of asymptomatic patients to exclude bone, thoracic, abdominal, and brain metastases, as well as surveillance imaging for the purposes of ruling out local recurrence.

CYP2D6 as a Treatment Decision Aid for ER-positive Non-metastatic Breast Cancer Patients: A Systematic Review With Accompanying Clinical Practice Guidelines

Year: 2019
AGREE II score: Unavailable
Developer organization: Canadian Pharmacogenomics Network for Drug Safety Clinical Recommendations Group
This is a clinical practice guideline for women with estrogen receptor (ER)-positive breast cancer. The role of CYP2D6 genotyping in these patients, in the context of tamoxifen therapy, is discussed. The guideline examines which patients should undergo CYP2D6 genotyping, which variants should be included in CYP2D6 tests, and which biological samples should be used for genotyping.

HER2-Targeted Treatment for Older Patients With Breast Cancer: An Expert Position Paper from the International Society of Geriatric Oncology

Year: 2019
AGREE II score: Available
Developer organization: International Society of Geriatric Oncology
This is a clinical practice guideline for older patients (i.e., over 70 years of age) with HER2-positive breast cancer. The primary objective of the guideline is to reduce the risk of cardiac events resulting from treatment-related cardiotoxicity, while still effectively reducing cancer-related morbidity and mortality. The guideline examines various anti-HER2 agents, and discusses their use in both adjuvant and neoadjuvant regimens.

Genetic / Familial High-Risk Assessment: Breast and Ovarian, Version 3.2019

Year: 2019
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for patients who may be at high-risk for developing breast and ovarian cancer due to genetic/familial predispositions. The guideline provides recommendations on genetic risk assessment and genetic counseling, and specifically discusses the management of individuals with hereditary breast or breast/ovarian syndromes, including BRCA-related breast/ovarian cancer syndrome, Li-Fraumeni syndrome, and Cowden syndrome.

Evidence Based Recommendations for the Assessment and Management of Radiation-Induced Skin Toxicities in Breast Cancer: Part 2. Skin Assessment for Breast Cancer Patients Receiving Radiation

Year: 2018
AGREE II score: Available
Developer organization: Cancer Care Manitoba
This is a clinical practice guideline for adults with breast cancer. The guideline provides recommendations on the assessment and management of radiation-induced skin toxicities in these patients. Outcomes of interest include quality of life, treatment compliance, and minimized patient burden regarding dressings (e.g. cost, frequency, and difficulty of dressing changes).

Magnetic Resonance Imaging Screening of Women at High Risk for Breast Cancer

Year: 2018
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for women at very high risk for breast cancer. The guideline examines the effectiveness of screening using magnetic resonance imaging (MRI) in these patients, in addition to standard screening (mammography). Optimal frequency of MRI screening, subgroups that may benefit more from MRI screening, and associated harms are discussed. Workup and follow-up are also considered for those patients who have abnormal findings seen only on MRI imaging.

Management of Ductal Carcinoma In Situ of the Breast

Year: 2018
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for women with ductal carcinoma in situ (DCIS) of the breast. The guideline examines the optimal surgical management of these patients, as well as radiotherapy in patients who have undergone breast-conserving surgery. The role of tamoxifen in the management of these patients is also discussed.

Guidelines for Early Detection of Breast Cancer in Brazil II – New National Recommendations, Main Evidence, and Controversies

Year: 2018
AGREE II score: Available
Developer organization: Brazilian Ministry of Health
This is a clinical practice guideline for the screening and early diagnosis of breast cancer in Brazil. The guideline examines various early detection strategies stratified by age bracket and periodicity. The primary outcome of interest is the improvement in breast cancer detection, based on the optimization of program specificity and sensitivity.

Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update

Year: 2018
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This clinical practice guideline is a focused update of the American Society of Clinical Oncology's 2016 adaptation of Cancer Care Ontario's guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer and adjuvant targeted therapy for breast cancer. New recommendations are provided on the addition of adjuvant capecitabine after completion of standard preoperative anthracycline- and taxane-based combination chemotherapy, the addition of 1 year of adjuvant pertuzumab to combination chemotherapy and trastuzumab, and the use of neratinib as extended adjuvant therapy in patients with early-stage human epidermal growth factor receptor 2 (HER2)-amplified or HER2-overexpressed breast cancer.

Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology / College of American Pathologists Clinical Practice Guideline Focused Update

Year: 2018
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This clinical practice guideline is a focused update of the American Society of Clinical Oncology / College of American Pathologists 2013 guideline on human epidermal growth factor receptor 2 (HER2) testing in breast cancer. Recommendations are provided around what the most appropriate definition is for immunohistochemistry (IHC) 2+, whether HER2 testing should be repeated on surgical specimens if initial core biopsy results are negative, and which invasive cancers should be considered in situ hybridization (ISH) positive. In addition, appropriate diagnostic workup is discussed for invasive cancers based on the HER2 signals present.

Radiation Therapy for the Whole Breast: An American Society for Radiation Oncology (ASTRO) Evidence-Based Guideline

Year: 2018
AGREE II score: Available
Developer organization: American Society for Radiation Oncology
This is a clinical practice guideline for women with breast cancer. The guideline examines fractionation for whole-breast irradiation (WBI), including appropriate dose-fractionation schemes for patients based on various disease and demographic factors. Treatment planning and delivery for WBI and a sequential tumour bed boost are also considered.

Adjuvant Endocrine Therapy in Premenopausal Patients With Hormone Receptor-Positive Early Breast Cancer: Evidence Evaluation and GRADE Recommendations by the Italian Association of Medical Oncology (AIOM)

Year: 2018
AGREE II score: Available
Developer organization: The Italian Association of Medical Oncology
This is a clinical practice guideline for premenopausal patients with hormone receptor-positive early breast cancer. The guideline examines adjuvant ovarian function suppression (OFS) during the treatment of these patients. The addition of OFS to tamoxifen therapy is discussed for low-risk and high-risk patients, as well as the use of aromatase inhibitors instead of tamoxifen in high-risk patients.

Early and Locally Advanced Breast Cancer: Diagnosis and Management

Year: 2018
AGREE II score: Available
Developer organization: National Institute for Health and Care Excellence
This is a clinical practice guideline for the diagnosis and management of early and locally advanced breast cancer. The guideline provides recommendations on referral, diagnosis, preoperative assessment, genetic testing, surgical procedures, breast reconstruction, psychological support, and adjuvant therapies such as endocrine therapy and bisphosphonate therapy.

Breast Cancer Risk Reduction, Version 2.2018

Year: 2018
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for women who are at increased risk of developing breast cancer. The guideline examines the elements of risk, risk assessment, risk-reduction interventions, and the components of risk-reduction counselling. Risk-reduction interventions considered are lifestyle modifications, risk-reduction surgery, and risk-reduction agents including Tamoxifen, Raloxifene, and Aromatase. Monitoring patients on risk reduction agents, and managing the side effects of these agents are also discussed.

Breast Cancer, Version 1.2018

Year: 2018
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for women with breast cancer. The guideline examines staging, pathology assessment, and treatment approaches for pure noninvasive carcinomas, stage I, IIA, IIB, IIIA, or III invasive breast cancer, and stage IV metastatic or recurrent breast cancer. Special situations considered include Paget's disease, phyllodes tumours of the breast, breast cancer during pregnancy, inflammatory breast cancer, and axillary breast cancer.

Recommendations for Filgrastim Use in Adults by Disease Site

Year: 2018
AGREE II score: Unavailable
Developer organization: Cancer Care Manitoba
This is a clinical practice guideline for adult oncology patients with neutropenia. The guideline examines the appropriate prescribing of filgrastim for these patients. Indications for which filgrastim should be used are discussed by disease site group. Disease site groups considered include breast, central nervous system, gastrointestinal, gynecologic, genitourinary, hematologic, and thoracic, amongst others.

Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update

Year: 2018
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This clinical practice guideline is a focused update of the American Society of Clinical Oncology's 2016 guideline on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. The guideline specifically examines whether extended adjuvant therapy, including the use of aromatase inhibitors (AIs), improves clinically meaningful outcomes (e.g. disease-free survival, overall survival, quality of life, toxicity) after 5 years of sequential endocrine therapy in postmenopausal women with hormone receptor-positive early breast cancer.

Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline

Year: 2018
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for patients undergoing treatment for breast cancer and for survivors of breast cancer. The guideline examines the use of complementary integrated therapies for the management of symptoms of disease as well as for the management of adverse effects associated with treatment. Recommendations are grouped within the following categories: acute radiation skin reaction, anxiety and stress reduction, chemotherapy-induced nausea and vomiting, depression and mood disturbances, fatigue, lymphedema, neuropathy, pain, quality of life, sleep disturbances, and vasomotor/hot flashes.

ACR Appropriateness Criteria Evaluation of the Symptomatic Male Breast

Year: 2018
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for men who are experiencing breast symptoms. The guideline examines the appropriateness of various imaging modalities during clinical investigations in this population. Specific situations addressed include the initial imaging of men with an indeterminate palpable breast mass (with further divisions based on age), mammography or digital breast tomosynthesis for indeterminate or suspicious masses, as well as initial imaging of men whose physical examinations have raised suspicion of breast cancer.

ACR Appropriateness Criteria Breast Imaging of Pregnant and Lactating Women

Year: 2018
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for pregnant and lactating women. The guideline examines the appropriateness of various breast imaging techniques for the purpose of identifying pregnancy-associated breast cancer (PABC). Specific situations addressed include breast cancer screening during lactation, breast cancer screening during pregnancy (with further divisions based on age), imaging in women with a palpable breast mass, imaging in women with clinically suspicious nipple discharge during pregnancy, and staging of newly diagnosed breast cancer during pregnancy.

Evidence Based Recommendations for the Assessment and Management of Radiation-Induced Skin Toxicities in Breast Cancer: Part 4. Management of Acute Radiation-Induced Skin Toxicities

Year: 2018
AGREE II score: Available
Developer organization: Cancer Care Manitoba
This clinical practice guideline if part of a series of guidelines for adults with breast cancer who are experiencing radiation-induced skin toxicities. The guideline focuses on the clinical assessment and management of these patients. Outcomes of interest include improved care delivery and quality of life, enhanced treatment compliance, as well as minimized patient burden regarding dressings (i.e. cost, frequency/difficulty of dressing changes).

Evidence Based Recommendations for the Assessment and Management of Radiation-Induced Skin Toxicities in Breast Cancer: Part 3. Skin Health Promotion: Health Promotion Interventions

Year: 2018
AGREE II score: Available
Developer organization: Cancer Care Manitoba
This clinical practice guideline if part of a series of guidelines for adults with breast cancer who are experiencing radiation-induced skin toxicities. The guideline provides recommendations regarding interventions aimed at the promotion of skin health. Specific topics discussed include the promotion of skin hygiene, promotion of comfort, preventing infections, protection from trauma, and protection from the environment.

Recommendations on Screening for Breast Cancer in Women Aged 40–74 Years Who are not at Increased Risk for Breast Cancer

Year: 2018
AGREE II score: Available
Developer organization: Canadian Task Force on Preventive Health Care
This is a clinical practice guideline for women aged 40-74 who are not at an increased risk for developing breast cancer. The guideline discusses breast cancer screening in this population, and provides specific recommendations on appropriate screening modalities. Recommendations for screening are based on age.

Breast Cancer Screening and Diagnosis, Version 3.2018

Year: 2018
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for women who have been diagnosed with or are at risk of developing breast cancer. The guideline examines the different methods of diagnosis and screening for breast cancer that will facilitate clinical decision-making. The guideline provides a consistent framework for screening and evaluating a spectrum of clinical breast lesions and takes into consideration different imaging modalities and screening recommendations for women at different levels of risk.

Genetic/Familial High-Risk Assessment: Breast and Ovarian, Version 2.2019

Year: 2018
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for patients who may be at high-risk for developing breast and ovarian cancer due to genetic/familial predispositions. The guideline provides recommendations on genetic risk assessment and genetic counseling, and specifically discusses the management of individuals with hereditary breast or breast/ovarian syndromes, including BRCA-related breast/ovarian cancer syndrome, Li-Fraumeni syndrome, and Cowden syndrome.

Breast Cancer Risk Reduction, Version 1.2019

Year: 2018
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for women who are at increased risk of developing breast cancer. The guideline examines the elements of risk, risk assessment, risk-reduction interventions, and the components of risk-reduction counselling. Risk-reduction interventions considered are lifestyle modifications, risk-reduction surgery, and risk-reduction agents including Tamoxifen, Raloxifene, Aromatase, Anastrozole and Exemestane. Monitoring patients on risk reduction agents, and managing the side effects of these agents are also discussed.

Breast Cancer, Version 3.2018

Year: 2018
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for patients with breast cancer. The guideline examines the staging, pathology assessment, and treatment approach for these patients. Pure non-invasive carcinomas (stage 0), stage 1, 2A, 2B or 3A (T3, N1, M0) invasive breast cancer, stage 3 invasive breast cancer, and stage 4 metastatic or recurrent breast cancer are discussed. Special situations including Paget's disease, phyllodes tumours of the breast, breast cancer during pregnancy, inflammatory breast cancer, and axillary breast cancer are also considered.

Evidence Based Recommendations for the Assessment and Management of Radiation-Induced Skin Toxicities in Breast Cancer: Part 5. Management of Long-Term Effects

Year: 2018
AGREE II score: Available
Developer organization: Cancer Care Manitoba
This clinical practice guideline if part of a series of guidelines for adults with breast cancer who are experiencing radiation-induced skin toxicities. The guideline focuses on the management of long term effects, and provides recommendations on 1 month post-treatment and late reactions to promote cleanliness, treat the wound, prevent infections, protect from trauma and the environment, promote skin health and maintain skin flexibility.

Dutch Breast Reconstruction Guideline

Year: 2018
AGREE II score: Unavailable
Developer organization: Netherlands Society for Plastic and Reconstructive Surgery
This is a clinical practice guideline for patients undergoing breast-conserving therapy or mastectomy for breast cancer, or who have undergone prophylactic mastectomy. The guideline provides recommendations for breast reconstructive techniques and radiation therapy following mastectomy. The timing and type of breast reconstruction in combination with other oncological treatments is discussed, as is the treatment of high-risk patients.

Provincial Consensus Recommendations for Adjuvant Systemic Therapy for Breast Cancer

Year: 2017
AGREE II score: Unavailable
Developer organization: Cancer Care Manitoba
This is a clinical practice guideline for patients with breast cancer. The guideline examines common approaches for the treatment of breast cancer with adjuvant systemic therapy. A specific topic discussed is the use of adjuvant therapy for HER2 positive breast cancer, with recommendations for both oncologists and pathologists.

3rd ESO–ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 3)

Year: 2017
AGREE II score: Unavailable
Developer organization: European School of Oncology
This is a clinical practice guideline for the management of patients with advanced breast cancer (ABC), including those with locally advanced breast cancer (LABC) and metastatic breast cancer (MBC). The guideline provides recommendations for the management of these patients, and specifically discusses the use of chemotherapy, management of bone metastases, management of cancer related fatigue, as well as supportive and palliative care.

The American Brachytherapy Society Consensus Statement for Accelerated Partial-Breast Irradiation

Year: 2017
AGREE II score: Unavailable
Developer organization: American Brachytherapy Society
This is a clinical practice guideline on the use of accelerated partial-breast irradiation (APBI) as adjuvant radiation after breast-conserving surgery for patients with ductal carcinoma in situ and early-stage invasive breast cancer. The guideline provides recommendations regarding appropriate patient selection and techniques to deliver APBI. Patient selection criteria include age, tumour size, histology, estrogen receptor response, surgical margins, lymphovascular space invasion and nodal status. Efficacy and toxicity are considered with respect to recommendations for the appropriate and safe utilization of APBI.

Indications for Use of Breast Magnetic Resonance Imaging (MRI)

Year: 2017
AGREE II score: Unavailable
Developer organization: Eastern Health
This is a clinical practice guideline for the appropriate use of breast magnetic resonance imaging (MRI). The guideline examines indications for breast MRI use, such as for the screening of high risk individuals, for problem solving when mammographic, sonographic or clinical findings are suspicious but inconclusive, for the assessment of positive margins following breast cancer surgery or neoadjuvant chemotherapy, and for the assessment of breast implant integrity.

Accelerated Partial Breast Irradiation: Update of an ASTRO Evidence-Based Consensus Statement

Year: 2017
AGREE II score: Available
Developer organization: American Society for Radiation Oncology
This is an update to the American Society for Radiation Oncology's evidence-based consensus statement on accelerated partial breast irradiation (APBI). The focus of the update centers on the selection criteria for APBI and intraoperative radiation therapy (IORT) for partial breast irradiation outside of a clinical trial.

Clinical Practice Guidelines on the Evidence-Based Use of Integrative Therapies During and Following Breast Cancer Treatment

Year: 2017
AGREE II score: Available
Developer organization: Society for Integrative Oncology
This is a clinical practice guideline for patients with breast cancer. The guideline examines the use of integrative therapies for specific clinical indications during and after breast cancer treatment. The integrative therapies discussed in the guideline address anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance.

Guidance for Kyphoplasty and Vertebroplasty for Cancer Patients in Ontario: Recommendations Report 2017

Year: 2017
AGREE II score: Unavailable
Developer organization: Cancer Care Ontario
This guideline provides recommendations on use of vertebroplasty or kyphoplasty as treatment options for cancer patients with vertebral compression fractures. The guideline outlines clinical criteria for when vertebroplasty, kyphoplasty, or focal tumour ablation (FTA) assisted vertebroplasty/kyphoplasty should be performed, and provides recommendations on selecting the most appropriate procedure. The role of radiation treatment, absolute contraindications, and service provider requirements are also discussed.

ACR Appropriateness Criteria Evaluation of Nipple Discharge

Year: 2017
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for women and men of all ages who are experiencing nipple discharge. The guideline discusses different imaging modalities used to identify the causes of nipple discharge, such as mammography, digital breast tomosynthesis, ultrasound (US), magnetic resonance imaging (MRI) with or without intravenous (IV) contrast, fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission mammography (FDG-PEM), Tc-99m sestamibi molecular breast imaging (MBI), and ductography. In addition, image-guided core biopsy and image-guided fine needle aspiration are discussed as options for histologic diagnosis once suspicious lesions are identified. The guideline examines the appropriateness of these techniques for five clinical situations that are based on sex, age, and whether or not discharge is physiologic or pathologic.

ACR Appropriateness Criteria Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer

Year: 2017
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for patients with locally advanced invasive breast cancer who are being treated with, or considered for, neoadjuvant systemic therapy. The guideline examines imaging methods used to monitor responses to neoadjuvant systemic therapy, from pre-treatment to post-treatment. Digital mammography, digital breast tomosynthesis, ultrasound (US), and magnetic resonance imaging (MRI) are discussed as the key imaging modalities used.

Breast Magnetic Resonance Imaging (MRI) and High Risk Hereditary Breast Cancer

Year: 2017
AGREE II score: Unavailable
Developer organization: Eastern Health
This is a clinical practice guideline for patients at high risk for developing hereditary breast cancer. The guideline examines the breast screening protocol for these patients. Recommendations are provided on the frequency and age of initiation for mammography screening and breast MRI, as well as the timing of breast MRI in the menstrual cycle. Criteria for determining patients who are at high risk of developing hereditary breast cancer are also provided.

Breast Cancer Screening: Updated Recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

Year: 2017
AGREE II score: Unavailable
Developer organization: Brazilian College of Radiology and Diagnostic Imaging
This is a clinical practice guideline for adult patients who may be at risk for developing breast cancer. The guideline examines breast cancer screening for this patient population at different levels of risk. Different screening options such as mammography, ultrasound, magnetic resonance imaging, and tomosynthesis are discussed.

Genetic/Familial High-Risk Assessment: Breast and Ovarian, Version 1.2018

Year: 2017
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for patients who may be at high-risk for developing breast and ovarian cancer due to genetic/familial predispositions. The guideline provides recommendations on genetic risk assessment and genetic counseling, and specifically discusses the management of individuals with hereditary breast or breast/ovarian syndromes, including BRCA-related breast/ovarian cancer syndrome, Li-Fraumeni syndrome, and Cowden syndrome.

ACR Appropriateness Criteria Breast Cancer Screening

Year: 2017
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for screening women who may be at risk of having breast cancer. The guideline examines effective screening methods, particularly focusing on mammography, digital breast tomosynthesis (DBT), magnetic resonance imaging (MRI), and ultrasound (US). Outcomes of interest include disease progression, screening sensitivity, and screening accuracy.

Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: A Cancer Care Ontario and American Society of Clinical Oncology Clinical Practice Guideline

Year: 2017
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for patients with early or locally advanced (nonmetastatic) breast cancer. The guideline examines the use of bisphosphonates and other bone-modifying agents as adjuvant therapy in patients with breast cancer. Outcomes of interest include recurrence and survival, with focus on the dependency of effectiveness on age or menopausal status.

18F-FDG PET/CT in Breast Cancer: Evidence-Based Recommendations in Initial Staging

Year: 2017
AGREE II score: Available
Developer organization: Spanish Society of Nuclear Medicine and Molecular Imaging
This is a clinical practice guideline on the role and appropriateness of fluorodeoxyglucose positron emission tomography - computed tomography (18F-FDG PET/CT) for initial breast cancer staging and its therapeutic and prognostic impact. Recommendations are stratified by risk, and outcomes of interest include sensitivity, specificity, change in stage compared to staging done by conventional imaging, prognosis, and costs. The guideline also addresses the association of metabolic information with biology and prognosis.

Role of Bone-Modifying Agents in Metastatic Breast Cancer: An American Society of Clinical Oncology-Cancer Care Ontario Focused Guideline Update

Year: 2017
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This clinical practice guideline is a focused update of the American Society of Clinical Oncology's 2016 guideline titled American Society of Clinical Oncology Clinical Practice Guideline Update: Recommendations on the Role of Bone-modifying Agents in Metastatic Breast Cancer. The guideline examines the role of bone-modifying agents (BMAs) in the treatment of patients with metastatic breast cancer, while specifically focusing on the intervals between doses of zoledronic acid, and the use of BMA's to control pain secondary to bone metastases. In addition to zolendronic acid, BMA's compared include denosumab, and pamidronate.

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update

Year: 2017
AGREE II score: Available
Developer organization: Clinical Pharmacogenetics Implementation Consortium
This is a clinical practice guideline for patients with colorectal cancer, breast cancer, or cancers of the aerodigestive tract, who are being considered for treatment with fluoropyrimidines (5-fluorouracil and capecitabine). The guideline provides recommendations for the interpretation of clinical dihydropyrimidine dehydrogenase (DPYD) genotype tests so that the results can be used to guide fluoropyrimidine dosage. The primary outcome of interest is reduced toxicity among individuals with subnormal DPYD metabolism.

Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction With DIEP or Pedicled TRAM Abdominal Flaps

Year: 2017
AGREE II score: Available
Developer organization: American Society of Plastic Surgeons
This is a clinical practice guideline for patients who have been diagnosed with breast cancer. The guideline examines breast reconstruction, specifically reconstruction with deep inferior epigastric perforator (DIEP) flap and pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, to treat breast defects in these patients, which may be a result of mastectomy. Outcomes of interest include clinical complications and patient satisfaction.

Breast Reconstruction Following Prophylactic or Therapeutic Mastectomy for Breast Cancer

Year: 2017
AGREE II score: Available
Developer organization: Alberta Health Services
This clinical practice guideline provides recommendations for breast reconstruction in women following mastectomy for the prevention or treatment of breast cancer. The guideline discusses patient education, eligibility for reconstruction, timing of reconstruction, factors that enhance recovery from reconstruction, post-reconstruction surveillance, and measuring outcomes of construction. The benefits and risks of implant-based, autologous flap, and combination reconstruction procedures are examined. The guideline also discusses the extent to appropriately perform mastectomy.

Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Focused Update

Year: 2017
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This clinical practice guideline is a focused update of the American Society of Clinical Oncology's 2016 guideline titled Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women with Early-stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. The update discusses the use of MammaPrint to guide decisions on the use of adjuvant systemic therapy by examining both the publication of the phase III randomized MINDACT (Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy) study and other published literature on the MammaPrint assay for evidence of clinical utility. The guideline examines the contexts in which the MammaPrint assay will be beneficial for improving treatment decisions.

Breast Cancer Reconstruction Surgery (Immediate and Delayed) Across Ontario: Patient Indications and Appropriate Surgical Options

Year: 2016
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for women with breast cancer who have chosen or been recommended for therapeutic mastectomy, and women who are at high risk for breast cancer who have chosen or been recommended prophylactic mastectomy. The guideline considers the suitability of patients for immediate or delayed breast cancer reconstruction surgery, appropriate timing of treatment, and optimal surgical techniques. Techniques examined include skin-sparing mastectomy (SSM), nipple-sparing mastectomy (NSM) and areola-sparing mastectomy, as well as autologous tissue and implant-based reconstruction.

Management of Menopausal Symptoms in Women With a History of Breast Cancer

Year: 2016
AGREE II score: Available
Developer organization: Cancer Australia
This is a clinical practice guideline for women with a history of breast cancer. The guideline examines the management of menopausal symptoms in these patients. Non-pharmacological, pharmacological, and hormonal therapies are considered for vasomotor symptoms, sleep disturbance, vulvovaginal symptoms, and sexual function. Depression and anxiety, mood and emotional well-being, mental health, global quality of life, and breast cancer recurrence are also discussed.

Recommendations for Filgrastim Use in Adults by Disease Site

Year: 2016
AGREE II score: Unavailable
Developer organization: Cancer Care Manitoba
This is a clinical practice guideline to guide appropriate prescribing of filgrastim in adults. The guidelines looks at a variety of disease sites and is intended as a guide to facilitate a shared approach to the appropriate use of filgrastim. In order provide clarity surrounding the indications in which filgrastim should be used, the recommendations are presented by disease site.

Myeloid Growth Factors – Version 2.2016

Year: 2016
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for the use of myeloid growth factors in adult patients with solid tumours and non-myeloid malignancies. Benefits and risks are reviewed, the role of biosimilars is discussed, and recommendations are provided for prophylactic and therapeutic uses of both granulocyte and granulocyte-macrophage colony stimulating factors (CSFs). Recommendations are also given regarding the use of CSFs in the hematopoietic cell transplant setting. Outcomes of interest include efficacy of CSFs, mortality, length of hospitalization, toxicity, and adverse effects.

ACR Appropriateness Criteria on Breast Screening

Year: 2016
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for breast cancer screening. The guideline provides recommendations based on three different variants: 1. high-risk women (women with a BRCA mutation and their untested, first-degree relatives, women with a history of chest irradiation between the ages of 10-30, women with 20% or greater lifetime risk of breast cancer); 2. intermediate-risk women (women with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15-20% lifetime risk of breast cancer); 3. average-risk women (women with <15% lifetime risk of breast cancer, breasts not dense). Recommendations consider the appropriateness of mammography, digital breast tomosynthesis (DBT), magnetic resonance imaging (MRI), ultrasound, as well as other imaging modalities.

Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

Year: 2016
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for women with early-stage invasive breast cancer. The guideline provides recommendations on use of breast tumour biomarker assay results to inform decisions on adjuvant therapy. Several markers are reviewed including 21 gene recurrence score (Oncotype DX), 12 gene risk score (EndoPredict), 70 gene assay (MammaPrint), 50 gene subtype predictor (PAM50 Risk of Recurrence), Breast Cancer Index (BCI), 5 protein panel risk specification (Mammostrat), immunohistochemistry 4 (IHC-4), urokinase plasminogen activator and plasminogen activator inhibitor type 1 (uPA and PAI-1), circulating tumour cells (CTCs), tumour-infiltrating lymphocytes (TILs), and protein encoded by the MKI67 gene. Additionally, the guideline provides recommendations on the use of specific biomarkers to guide choice of specific drugs and regimes. Outcomes of interest include overall survival and disease-free or recurrence-free survival.

Breast Cancer Screening and Diagnosis – Version 1.2016

Year: 2016
AGREE II score: Unavailable
Developer organization: National Comprehensive Cancer Network
A clinical practice guideline for women who may be at risk for breast cancer or who qualify for breast cancer screening. The guideline examines screening for average and increased risk, and diagnostic evaluation including mammography, MRI, ultrasound, and tissue biopsy. Outcomes of interest include adverse events, delayed diagnosis, and probability of malignancy.

Genetic/Familial High-Risk Assessment: Breast and Ovarian – Version 1.2017

Year: 2016
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for individuals at risk of or having genetic mutations that increase their risk of breast or ovarian cancer. The guideline reviews hereditary breast or breast/ovarian cancer syndrome, Li-Fraumeni syndrome, Cowden syndrome/PTEN Hamartoma tumor syndrome, and other genetic mutations associated with breast/ovarian cancer. Recommendations are provided for initial risk assessment, formal risk assessment and genetic counselling, and management options for individuals with a clinical diagnosis following genetic testing.

Clinical Utility of Multigene Profiling Assays in Invasive Early-Stage Breast Cancer

Year: 2016
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for women diagnosed with invasive early-stage breast cancer. The guideline discusses the use of different multigene profiling assays for determining risk profiles (high-risk vs low-risk) in patients with estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative tumours. The validity and clinical utility of different assays are examined, including Oncotype DX, Prosigna, MammaPrint, EndoPredict, and EPclin. In addition, assays are specifically compared to Oncotype DX, the only assay that was publicly funded and part of standard practice in Ontario at the time of publication.

Breast Cancer – Version 2.2016

Year: 2016
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This clinical practice guideline reviews workup, staging, and treatment for both noninvasive and invasive breast cancer. Special considerations include phyllodes tumor, Paget's disease, breast cancer during pregnancy, and inflammatory breast cancer. Treatment recommendations for invasive cancer are stratified by tumor receptor status and stage. Fertility and birth control is also discussed.

ACR Appropriateness Criteria Locally Advanced Breast Cancer

Year: 2016
AGREE II score: Available
Developer organization: American College of Radiology
A clinical practice guideline for patients with locally advanced breast cancer. The guideline examines appropriate screening to determine extent and node involvement, and treatment through systemic therapies and radiotherapies. Outcomes of interest include improved breast conservation in select populations and improved outcomes through trimodal therapy.

Society of Surgical Oncology – American Society for Radiation Oncology – American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ

Year: 2016
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This guideline applies to patients with ductal carcinoma in situ (DCIS) treated with whole-breast radiation therapy (WBRT). The primary question addressed in this guideline is "what margin width minimizes the risk of ipsi-lateral breast tumor recurrence (IBTR) in patients with DCIS receiving breast-conserving surgery?" The guideline developed from a consensus panel is intended to assist treating physicians and patients in the clinical decision-making process based on the best available evidence.

Molecular Biomarker Discordance between Primary and Recurrent/Metastatic Breast Cancer

Year: 2016
AGREE II score: Unavailable
Developer organization: Eastern Health
A clinical practice guideline for patients with a history of breast cancer. The guideline examine the use of biopsies and retesting of estrogen receptor (ER), progesterone receptor (PR) and HER2-neu receptor (HER2) to determine recurrence or metastases. Outcomes of interest include progression-free and overall survival.

ACR Appropriateness Criteria Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women

Year: 2016
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for stage I breast cancer, and focuses specifically on the initial workup and surveillance for local recurrence and distant metastases in asymptomatic women. Recommendations are made with different variants in mind, including newly diagnosed cases, surveillance, and ruling out brain metastases, liver metastases, and thoracic metastases. The guideline also considers the appropriateness of different imaging procedures to detect or rule out metastasis.

ACR Appropriateness Criteria on Breast Pain

Year: 2016
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for breast pain. Recommendations are made with consideration of the two main types of breast pain: 1. cyclical breast pain (diffuse unilateral or bilateral pain and/or tenderness, often accompanied by swelling, that waxes and wanes with the menstrual cycle); 2. noncyclical breast pain (predominantly inflammatory in nature, rather than hormonal in origin. It is usually unilateral, and tends to be more focal than cyclical breast pain). The guideline provides guidance on the examination of breast pain with recommendations considering different types of imaging options.

Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

Year: 2016
AGREE II score: Available
Developer organization: United States Preventive Services Task Force
This is an update of the 2009 recommendation on screening for breast cancer. The recommendations apply to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as BRCA1 or BRCA2 gene mutation or other familial cancer syndrome) or a history of chest radiation at a young age. The recommendations consider the benefits of screening mammography and digital breast tomosynthesis (DBT) as well as the potential harms.

The Japanese Guidelines for Breast Cancer Screening

Year: 2016
AGREE II score: Available
Developer organization: Japanese Research Group for the Development of Breast Cancer Screening Guidelines
This is a clinical practice guideline for the screening of breast cancer in asymptomatic women. Different screening modalities are compared, such as mammographic screening with clinical breast examination, clinical breast examination, and ultrasonography with and without mammography. Age-based recommendations are made regarding the most appropriate screening modalities.

Fertility Drugs and Cancer: A Guideline

Year: 2016
AGREE II score: Unavailable
Developer organization: American Society for Reproductive Medicine
This clinical practice guideline examines the impact of fertility drugs on the risk of cancer in women. The guideline looks at the association between use of fertility drugs and increased risk of developing invasive ovarian, breast, endometrial, colon and thyroid cancers as well as non-Hodgkin lymphoma and malignant melanoma. The association between fertility drugs and borderline ovarian tumours is also examined.

Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

Year: 2016
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for patients with early-stage breast cancer. The guideline provides recommendations regarding the use of sentinel node biopsy (SNB) for determining the extent to which patients' breast cancer has spread. Outcomes of interest include when to use SNB, and potential benefits and harms associated with SNB.

Adjuvant Systemic Therapy for Early Stage (Lymph Node Negative and Lymph Node Positive) Breast Cancer

Year: 2016
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This clinical practice guideline examines adjuvant systemic therapy for early stage breast cancer. The guideline provides a systematic method for treatment decision-making for patients with lymph node negative breast cancer and lymph node positive breast cancer, based on level of risk and hormone receptor status. The guideline further explores chemotherapy options for these patients and considers the influence of menopausal status on treatment decisions.

ACR Appropriateness Criteria Palpable Breast Mass

Year: 2016
AGREE II score: Available
Developer organization: American College of Radiology
A clinical practice guideline for patients with palpable breast masses. The guideline examines imaging modalities, including mammography, digital breast tomosynthesis, and ultrasound, based on clinical variants. Outcomes of interest include sensitivity and accuracy.

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update

Year: 2016
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
The American Society of Clinical Oncology (ASCO) guideline for the use of postmastectomy radiotherapy (PMRT) was published in 2001. This update of that guideline, completed in collaboration with the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO), focuses on key areas of ongoing controversy, including the use of PMRT for patients with one to three positive lymph nodes, use of PMRT for patients undergoing neoadjuvant systemic therapy (NAST), and selected technical aspects of PMRT, particularly the extent of regional nodal irradiation (RNI). The question of whether PMRT is indicated in women with T1-2 tumours and a positive sentinel node biopsy (SNB) who do not undergo completion axillary lymph node dissection (ALND) is also discussed.

Endocrine Therapy for Hormone Receptor–Positive Metastatic Breast Cancer: American Society of Clinical Oncology Guideline

Year: 2016
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This a clinical practice guideline for women with hormone receptor (HR) -positive metastatic breast cancer (MBC). The guideline provides treatment recommendations for HR-positive MBC patients who are being considered for endocrine therapy. Recommendations are based on the answers to a number of different of questions including: Is there an optimal first-line endocrine therapy regimen for hormone receptor (HR) –positive metastatic breast cancer (MBC); is there an optimal second- or later-line endocrine therapy for HR-positive MBC; and how does adjuvant treatment affect recommendations for treatment in the metastatic or advanced setting.

Breast Cancer Risk Reduction – Version 1.2016

Year: 2016
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for women who are at increased risk of developing breast cancer. The guideline provides an overview on risk assessment, risk-reduction interventions including lifestyle interventions, risk-reduction surgery, and risk-reduction agents (tamoxifen, raloxifene, aromatase inhibitors). Recommendations are also provided for managing side effects of risk-reduction agents and monitoring for complications. Risk-reduction counselling is also discussed.

Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update on Ovarian Suppression

Year: 2016
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for premenopausal women with Stage I to III hormone receptor-positive breast cancer. The guideline reviews the use of ovarian suppression in addition to standard adjuvant or standard therapy, with recommendations stratified by risk. Outcomes of interest included survival (overall, disease free), freedom from breast cancer at 5 years, freedom from distant recurrence at 5 years, adverse events, quality of life, patient-reported outcomes, and cognitive impairment.

The Japanese Breast Cancer Society Clinical Practice Guideline for Radiotherapy of Breast Cancer

Year: 2015
AGREE II score: Unavailable
Developer organization: Japanese Breast Cancer Society
A clinical practice guideline for patients for have undergone surgery for breast cancer, or have metastatic breast cancer. The guideline examines the utility of radiotherapy in breast-conserving surgery, post-mastectomy, and metastasis. Outcomes of interest include recurrence, death risk, and overall survival.

Breast Cancer Screening for Women at Average Risk

Year: 2015
AGREE II score: Available
Developer organization: American Cancer Society
A clinical practice guideline for screening mammography in women at average risk for breast cancer. The guideline examines screening regularity and the relative benefits and harms of screening modalities, focusing primarily on mammography. Outcomes of interest include reduced harm through false-positives and improved breast cancer mortality.

Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

Year: 2015
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for female patients with metastatic breast cancer. The guideline examines whether biomarkers should be used to guide decisions on systemic therapy. Topics of interest include the clinical utility of sampling metastatic tumours to test for changes from the primary tumour with respect to endocrine receptor (ER/PR) or HER2 status, and whether additional clinical biomarkers beyond ER/PR/HER2 have shown clinical utility in initiating or directing clinical therapy, or guiding decisions on switching to a different regime or discontinuing treatment. Outcomes of interest include survival (overall, progression-free), quality of life, and cost effectiveness. The guideline examines whether changes to systemic therapy based on biomarker status improves health outcomes, quality of life and/or cost effectiveness. Specifically, the guideline reviews the testing of metastatic tumour for changes from primary tumour with respect to ER, PR, and HER2 status, whether there is evidence of additional tumour markers that have demonstrated clinical utility to initiate or direct selection of systemic therapy, or to switch or discontinue a specific drug regime.

ACR Appropriateness Criteria Ductal Carcinoma In Situ

Year: 2015
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for women with the noninvasive breast cancer known as ductal carcinoma in situ (DCIS; intraductal carcinoma). The guideline examines the management options for DCIS, which commonly involves excision, radiotherapy, and hormonal therapy. Outcomes of interest include improvements in relapse-free survival and overall survival.

ACR Appropriateness Criteria Conservative Surgery and Radiation—Stage I and II Breast Cancer

Year: 2015
AGREE II score: Available
Developer organization: American College of Radiology
This is a clinical practice guideline for women with stage 1 and 2 breast cancer. The guideline discusses conservative surgery and radiation therapy, while specifically examining the National Institutes of Health (NIH) Consensus Conference statement, results of prospective randomized clinical trials, patient selection and evaluation, radiation therapy (RT) following conservative surgery, treatment techniques, the role of accelerated partial-breast irradiation (PBI), the integration of radiation and adjuvant systemic therapy, and follow-up care. The guideline discusses the appropriateness of different techniques for four unique clinical situations.

Follow-Up Care For Early-Stage Breast Cancer

Year: 2015
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This is a clinical practice guideline for patients who have completed active medical or radiation oncology treatment for early-stage breast cancer and who have been discharged by the cancer care centre for care by the referring physician. The guideline provides recommendations on responsibilities regarding follow-up care, follow-up investigations and surveillance, and signs and symptoms indicative of a breast cancer recurrence. Potential complications from cancer treatment and common survivorship concerns and challenges are also reviewed.

Breast Cancer Risk Reduction, Version 2.2015

Year: 2015
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for women who are at increased risk of developing breast cancer. The guideline provides an overview on risk assessment, risk-reduction interventions including lifestyle interventions, risk-reduction surgery, and risk-reduction agents (tamoxifen, raloxifene, aromatase inhibitors). Recommendations are also provided for managing side effects of risk-reduction agents and monitoring for complications. Risk-reduction counselling is also discussed.

Breast Cancer, Version 3.2015

Year: 2015
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This clinical practice guideline reviews workup, staging, and treatment for both noninvasive and invasive breast cancer. Special considerations include phyllodes tumour, Paget's disease, breast cancer during pregnancy, and inflammatory breast cancer. Treatment recommendations for invasive cancer are stratified by tumour receptor status and stage. Fertility and birth control are also discussed.

Effective Use of Advanced Practice Nurses in the Delivery of Adult Cancer Services in Ontario

Year: 2015
AGREE II score: Available
Developer organization: Cancer Care Ontario
This guideline provides recommendations on the use of advanced practice nurses (APNs) to optimize patient, provider, and health system outcomes across the cancer care continuum. Specifically, the guideline reviews patient populations and situations (types of needs, practice settings, phase of the cancer care continuum) for which APN roles have demonstrated equivalent or improved outcomes, or reduced harms in cancer care. Outcomes of interest include quality of life, physical, functional, psychosocial, and mental health, as well as morbidity, mortality, symptom management, patient and provider satisfaction, health care utilization, costs, and quality of care.

The Japanese Breast Cancer Society Clinical Practice Guideline for Screening and Imaging Diagnosis of Breast Cancer

Year: 2015
AGREE II score: Unavailable
Developer organization: Japanese Breast Cancer Society
A clinical practice guideline for women who may be at risk for breast cancer. The guideline examines effective screening and diagnosis methods, focusing on mammography with comparisons made to imaging techniques. Outcomes of interest include breast cancer outcomes, screening sensitivity, and accuracy.

Oncogenetic Testing and Follow-up for Women With Familial Breast/Ovarian Cancer, Li-Fraumeni Syndrome and Cowden Syndrome

Year: 2015
AGREE II score: Available
Developer organization: Belgian Health Care Knowledge Centre
This is a clinical practice guideline for adult women (18 years and older) either without breast cancer or with a recent diagnosis of breast cancer, who have a family history of breast, ovarian or a related cancer; the guideline also provides recommendations for men affected by male breast cancer. The guideline discusses oncogenetic testing aspects of breast cancer and ovarian, specifically hereditary breast cancer, the Li-Fraumeni syndrome, and the Cowden syndrome. Topics include criteria and indications for genetic testing, tests for which genes have clinical utility, and appropriate follow-up depending on results and family history.

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline

Year: 2015
AGREE II score: Available
Developer organization: American Cancer Society
This is a clinical practice guideline for primary care providers, medical oncologists, radiation oncologists and other clinicians caring for female adult breast cancer survivors. The guideline provides key recommendations for breast cancer survivorship care as it relates to surveillance and screening for breast cancer recurrence, risk evaluation and genetic counseling, and laboratory tests and imaging. Additionally, the guideline discusses the nature of support survivors should be provided with to address a number of psychosocial issues including depression, body image issues, financial challenges, and cognitive impairment.

Genetic/Familial High-Risk Assessment: Breast and Ovarian, Version 2.2015

Year: 2015
AGREE II score: Available
Developer organization: National Comprehensive Cancer Network
This is a clinical practice guideline for individuals at risk of or having genetic mutations that increase their risk of breast or ovarian cancer. The guideline reviews hereditary breast or breast/ovarian cancer syndrome, Li-Fraumeni syndrome, Cowden syndrome/PTEN Hamartoma tumour syndrome, and other genetic mutations associated with breast/ovarian cancer. Recommendations are provided for initial risk assessment, formal risk assessment and genetic counselling, and management options for individuals with a clinical diagnosis following genetic testing.

Suspected Cancer: Recognition and Referral

Year: 2015
AGREE II score: Available
Developer organization: National Institute for Health and Care Excellence
This is a clinical practice guideline for patients of all age groups suspected of having cancers including lung and pleural, upper gastro-intestinal, lower gastrointestinal, breast, gynecological, urological, skin, head and neck, brain and central nervous system, haematological, sarcomas, and childhood cancers. Recommendations are provided on recognition and referral or investigations of cancer in primary care. Outcomes of interest include quality of life, sensitivity and specificity of diagnostic tests and signs/symptoms, positive and negative predictive values of diagnostic tests and signs/symptoms, and cost effectiveness.

Adjuvant Radiotherapy for Ductal Carcinoma In Situ

Year: 2015
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This guideline provides recommendations on adjuvant radiotherapy for adult patients with ductal carcinoma in situ (DCIS) who have undergone breast conserving surgery (BCS) or mastectomy. The handling of close radial margin of excision after BCS is considered. Dose/fractionation schedule and acute toxicity are discussed, as are the side effects of radiotherapy.

Adjuvant Radiation Therapy For Invasive Breast Cancer

Year: 2015
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This is a clinical practice guideline for adult patients with invasive breast cancer who have had breast conserving surgery (BCS) or a mastectomy. The guideline reviews radiotherapy treatment according to lymph node status (positive or negative). Additionally, recommendations are provided for radiotherapy treatment with neoadjuvant chemotherapy, and the guideline discusses the risk of cardiac dose for patients with left-sided breast cancer and how this risk might be minimized.

Japan Breast Cancer Society Clinical Practice Guideline for Surgical Treatment of Breast Cancer

Year: 2015
AGREE II score: Unavailable
Developer organization: Japanese Breast Cancer Society
This is a clinical practice guideline for the surgical treatment of breast cancer. The guideline provides recommendations as they relate to breast-conserving therapy for ductal carcinoma in situ (DCIS), repeat lumpectomy after breast-conserving therapy, endoscopic surgery, breast reconstruction, and pharmacological therapy effective for postmastectomy pain syndrome (PMPS).

The Japanese Breast Cancer Society Clinical Practice Guideline for Systemic Treatment of Breast Cancer

Year: 2015
AGREE II score: Unavailable
Developer organization: Japanese Breast Cancer Society
This is a clinical practice guideline for systemic treatment of breast cancer. The guideline provides recommendations as they relate to preoperative endocrine therapy, preoperative chemotherapy, and, among others, aromatase inhibitor monotherapy. The guideline also provides recommendations as they relate to postoperative therapy options, recommendations for metastatic or recurrent breast cancer, and HER2-positive primary breast cancer.