Cancer Guidelines Database

Access quality cancer guidelines from a single Canadian source

We've listed 121 guidelines under your selection of "Type of cancer". The most recent guidelines are first.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Locoregional Therapy of Locally Advanced Breast Cancer (LABC)

Year: 2014
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for the treatment of female patients with locally advanced breast cancer. The guideline includes consideration of the role of breast-conserving surgery as compared with mastectomy. Other important aspects explored in the guideline include the role of radiotherapy following a mastectomy, as well as the treatment options for those female patients with locally advanced breast cancer who do not respond to initial neoadjuvant therapy.

Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stage I and II Invasive Breast Cancer: American Society of Clinical Oncology Endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology Consensus Guideline

Year: 2014
AGREE II score: Unavailable
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for patients with stage I and II breast cancer who have undergone whole-breast irradiation. The guideline examines minimization of recurrence risks through standardized adequate margin risks. Outcomes of interest include improving cosmetic outcomes and decreasing re-excision rates.

Adjuvant Radiation Therapy for Invasive Breast Cancer

Year: 2014
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 or a mastectomy. The guideline examines what is the optimal radiotherapy treatment after surgery for patients with T1, T2, T3, T4 invasive breast cancer according to lymph node status. Other outcomes of interest include: the manner in which a positive margin should be handled for patients with breast conserving surgery, as well as what the optimal radiotherapy treatment after surgery should be for patients with invasive breast cancer who have had neoadjuvant chemotherapy.

Recommendations for the Management of Central Nervous System (CNS) Metastases in Women with Secondary Breast Cancer

Year: 2014
AGREE II score: Available
Developer organization: Cancer Australia
This clinical practice guideline provides recommendations on the management of metastases in the central nervous system (CNS) in women with secondary breast cancer. Surgery, radiotherapy, systemic therapies, and multimodal treatment are reviewed. Diagnosis and management of spinal chord compression is also discussed. Outcomes of interest include survival, local control, progression free survival, recurrence of brain metastases, response rate, neurocognitive and psychological impairments, adverse events, and quality of life.

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

Year: 2014
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for female patients with hormone receptor–positive breast cancer. The guideline examines the use of adjuvant endocrine therapy, particularly with tamoxifen. Outcomes of interest include reduced recurrence improved mortality with extended tamoxifen therapy.

Breast Cancer Screening Clinical Practice Guideline

Year: 2014
AGREE II score: Available
Developer organization: Kaiser Permanente
This clinical practice guideline addresses breast cancer screening in asymptomatic women. Risk factors are discussed and recommendations are stratified by age and risk. Outcomes include risk estimates, over- and under- diagnosis harms, and screening effectiveness.

Optimal Systemic Therapy for Early Female Breast Cancer

Year: 2014
AGREE II score: Available
Developer organization: Cancer Care Ontario
A clinical practice guideline for female patients with early stage invasive breast cancer. The guideline examines systemic therapy selection based on patient and disease characteristics, and recurrence risk. Outcomes of interest include breast cancer-free intervals, disease-free survival, and clinically complete response.

Recommendations on Disease Management for Patients With Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer and Brain Metastases: American Society of Clinical Oncology Clinical Practice Guideline

Year: 2014
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for managing brain metastases in patients with human epidermal growth factor receptor 2 (HER2) –positive advanced breast cancer. The guideline examines local and systemic therapy treatment options based on prognosis and disease progression. Outcomes of interest include improved brain control and reduced risk of local recurrence.

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

Year: 2014
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for patients with early stage breast cancer who may be candidates for sentinel node biopsy. The guideline examines the use of sentinel node biopsy in relation to axillary lymph node dissection, with a focus on patients who have metastatic findings. Outcomes of interest include longer disease free survival and improved therapeutic efficacy.

Adjuvant Radiation Therapy for Ductal Carcinoma In Situ

Year: 2014
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This is a clinical practice guideline practice guideline for adult patients with ductal carcinoma in situ (DCIS) who have had breast-conserving surgery or a mastectomy. The guideline considers what the optimal radiotherapy treatment after surgery would be for patients with DCIS, as well as how a close radial margin of excision should be handled following breast conserving surgery. Additional areas of interest include: toxicity and side effects of radiotherapy.

Margins for Breast-conserving Surgery With Whole Breast Irradiation in Stage I and II Invasive Breast Cancer

Year: 2014
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This is a clinical practice guideline for patients with stage I or II invasive breast cancer. The guideline reviews the relationship between margin width and ipsilateral breast tumour recurrence (IBTR), and provides recommendations on adequate margin width in those patients undergoing breast conserving surgery and whole breast radiation therapy. Outcomes of interest include IBTR rate, risk of IBTR recurrence, and margin width.

Optimal Systemic Therapy for Early Female Breast Cancer

Year: 2014
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for female patients who are being considered for or are receiving systemic therapy for early-stage invasive breast cancer. The guideline examines the optimal adjuvant systemic therapy for female patients with early-stage operable breast cancer. Topics of interest include the use of chemotherapy, hormonal therapy, and targeted therapy, as well as patient and disease characteristics, and risk of recurrence.

Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement

Year: 2014
AGREE II score: Available
Developer organization: United States Preventive Services Task Force
This is a clinical practice guideline for women with no signs or symptoms of BRCA-related cancer. The guideline provides recommendations on risk assessment, genetic counselling, and genetic testing for potentially harmful BRCA1 or BRCA2 mutations in asymptomatic women. The guideline also examines interventions aimed at decreasing the risk for development of BRCA-related cancer in women with potentially harmful BRCA mutations in their family. Outcomes of interest include accuracy and adverse effects of BRCA mutation testing, and effectiveness of testing and risk-reducing treatments.

Required Reports for Referrals

Year: 2014
AGREE II score: Unavailable
Developer organization: BC Cancer Agency
This guideline set provides recommendations on required reports for referrals for: breast, gastrointestinal (esophagus, stomach, colon-rectum, anus, pancreas, liver, biliary tract/gall bladder), genitourinary (testis, prostate, bladder), gynecology (endometrium, cervix, ovary, vulva & vagina), head and neck (parotid & submandibular gland, thyroid, mouth, palate, nasopharynx, oropharynx, hypopharynx, nose & antrum, ear), lung, lymphoma and leukemia, melanoma, musculoskeletal and sarcoma, neuro-oncology, primary unknown, and skin (basal cell & squamous cell carcinomas, mycosis fungoides – Sezary syndrome). The guideline provides recommendations on pathology reports, operative reports, laboratory reports, and imaging reports. 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.

Breast Cancer

Year: 2014
AGREE II score: Unavailable
Developer organization: BC Cancer Agency
This is a clinical practice guideline for breast cancer. The guideline examines demographics and risk factors, prevention, screening and early detection, diagnosis, staging, management, and follow-up. Other important aspects explored in the guideline include: upper extremity rehab after axillary dissection, exercise for cardiovascular fitness, as well as benefits, risks, and costs. Please note that the sub-sections within this guideline were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline was accessed online.

Neo-Adjuvant (Pre-Operative) Therapy for Breast Cancer – General Considerations

Year: 2014
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This is a clinical practice guideline for patients 18 years or older with non-metastatic breast cancer. The guideline discusses neo-adjuvant therapy for breast cancer, including eligibility, advantages and dis-advantages, available therapies. Optimal treatment monitoring, surgical considerations, and the role of radiotherapy are also discussed. Outcomes of interest include prognostic factors, response rate, accuracy of diagnostic procedures, survival (disease-free, overall), and relapse rate.

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

Year: 2014
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This is a guideline for adjuvant systematic therapy for early stage (lymph node negative and lymph node positive) breast cancer. The guideline discusses risk categories for lymph node negative breast cancer, provides treatment recommendations for lymph node negative breast cancer, and explores chemotherapy options for lymph node negative breast cancer. Other areas of interest include: treatment recommendations for lymph node positive breast cancer, chemotherapy options for lymph node positive breast cancer, and adjuvant hormonal therapy for hormone receptor positive disease only.

Neoadjuvant Treatment of Primary Breast Cancer

Year: 2014
AGREE II score: Unavailable
Developer organization: Eastern Health
This is a clinical practice guideline for patients with a pathological confirmed diagnosis of breast cancer. The guideline reviews diagnostic assessment, staging, and neoadjuvant treatment regimes depending on whether breast cancer is operable or inoperable. The guideline also discusses challenges involved with neoadjuvant therapy.

Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

Year: 2014
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for systemic therapy treatments in patients with human epidermal growth factor receptor 2 (HER2) –positive advanced breast cancer. The guideline examines optimal first, second, and third line treatments based on progression and the presence of other receptor-positive diseases. Outcomes of interest include improved follow up, survival and toxicity profiles.

Advanced Breast Cancer (Update): Diagnosis and Treatment

Year: 2014
AGREE II score: Available
Developer organization: National Institute for Health and Care Excellence
A clinical practice guideline for patients with advanced breast cancer. The guideline examines diagnosis and treatment, focusing on systemic therapies, and provides patient-centred recommendations. Outcomes of interest include reductions in skeletal-related events and optimized drug sequencing.

Clinical Practice Guidelines on the Use of Integrative Therapies as Supportive Care in Patients Treated for Breast Cancer

Year: 2014
AGREE II score: Available
Developer organization: Society for Integrative Oncology
This is a clinical practice guideline for breast cancer patients currently undergoing cancer treatment. The guideline reviews the use of complementary and integrative therapies for the management of treatment related symptoms. Therapies such as acupuncture, hypnosis, meditation, relaxation and imagery, natural products (botanicals, minerals, vitamins), stress management and yoga are considered. Outcomes of interest include effectiveness of therapy for the management of clinical symptoms (such as fatigue, depression, pain, neuropathy, lymphedema, sleep, and anxiety, and chemotherapy-induced nausea and vomiting, among others), quality of life, organ toxicities, and adverse events.

Recommendations for Bowel Obstruction With Peritoneal Carcinomatosis

Year: 2014
AGREE II score: Available
Developer organization: French Society for Palliative Care
This is a clinical practice guideline for patients who have bowel obstruction with advanced peritoneal carcinomatosis for which complete cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion are no longer relevant. The guideline provides recommendations on clinical assessment and treatment options for relieving intestinal obstruction or its symptoms. Treatment/management options include surgery, steroids, stents, nasogastric tubes (NGT's) and venting gastronomy, antisecretory drugs, and antiemetic management. Outcomes of interest include complication rate of surgical management (e.g. obstruction, perforation), morbi-mortality rates from surgery, and quality of life.

ESO-ESMO 2nd International Consensus Guidelines for Advanced Breast Cancer (ABC2)

Year: 2014
AGREE II score: Unavailable
Developer organization: European School of Oncology
This is a clinical practice guideline for the treatment of patients with advanced breast cancer (ABC). Treatment options are discussed for inoperable locally advanced breast cancer (LABC), both inflammatory and non-inflammatory; and metastatic breast cancer (MBC), with recommendations specific to site of metastasis. Treatment recommendations are further stratified by cancer subtype (tumour status) and by specific populations including patients with BRCA-associated triple-negative or endocrine-resistant MBC and male patients with ABC.

Chemotherapy and Targeted Therapy for Women With Human Epidermal Growth Factor Receptor 2–Negative (or Unknown) Advanced Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline

Year: 2014
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for women with human epidermal growth factor receptor 2–negative (HER2-negative) or unknown advanced breast cancer. The guideline examines first-line treatment options including the benefits of single agent versus combination therapy, specifically the role of bevacizumab. Outcomes of interest include slowed disease progression, modestly improved survival, and increased communication concerning end of life planning.

Supportive Care During Treatment for Breast Cancer: Resource Allocations in Low- and Middle-income Countries

Year: 2013
AGREE II score: Unavailable
Developer organization: Breast Health Global Initiative
This clinical practice guideline discusses supportive care for patients undergoing breast cancer treatment in low- or middle-income countries. Resource allocation recommendations are provided for health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment.

Follow-Up Care for Early-Stage Breast Cancer

Year: 2013
AGREE II score: Unavailable
Developer organization: Alberta Health Services
A clinical practice guideline for patients who have completed treatment for early-stage breast cancer. The guideline examines surveillance follow-up for potential recurrence, with specific focus on potential complications from previous treatment. Outcomes of interest include improved management of endocrine therapy complications and improved lymphadema management.

Optimal Use of Taxanes in Metastatic Breast Cancer (MBC)

Year: 2013
AGREE II score: Unavailable
Developer organization: Alberta Health Services
This is a clinical practice guideline for adults over the age of 18 years with metastatic breast cancer who are anthracycline naïve or pre-treated/resistant. The guideline examines the use of taxane treatment for women depending on whether they have previously been treated with anthracycline, and whether or not the tumour shows HER2 overexpression. The guideline also reviews the use of taxanes to treat women who are anthracycline naïve or pretreated/resistant and paclitaxel or docetaxel intolerant. Outcomes of interest include risk of disease progression, toxicity rates, adverse effects of treatment, response rates, mortality, and quality of life.

Sentinel Node Biopsy in Breast Cancer

Year: 2013
AGREE II score: Unavailable
Developer organization: Eastern Health
This is a guideline for patients who have been diagnosed with cancer of the breast and meet the selection criteria for sentinel lymph node biopsy (SLNB). The guideline reviews SLNB versus axillary lymph node dissection (ALND) and provides recommendations on patient selection, optimal technique for the use of SLNB, and surgical training. Recommendations are provided for managing challenging situations including ALND when SN is positive, intraoperative assessment of SN(s), ductal carcinoma in situ (DCIS), and multiple sentinel nodes.

Breast Cancer: Management and Follow-up

Year: 2013
AGREE II score: Unavailable
Developer organization: Guidelines and Protocols Advisory Committee
This is a clinical practice guideline for women over 19 years of age who have biopsy-proven breast cancer. The guideline provides recommendations on specialist referral, treatment, and follow-up care including surveillance for breast cancer recurrence or new cancer, monitoring and treating complications and/or treatment side effects, and providing patient support.

The American Brachytherapy Society Consensus Statement for Accelerated Partial Breast Irradiation

Year: 2013
AGREE II score: Unavailable
Developer organization: American Brachytherapy Society
A clinical practice guideline for women with early-stage breast cancer. The guideline examines accelerated partial breast irradiation (APBI) as part of breast-conserving therapy, and provides treatment criteria recommendations. Outcomes of interest include improved patient selection and patient satisfaction.

Medications for Risk Reduction of Primary Breast Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement

Year: 2013
AGREE II score: Available
Developer organization: United States Preventive Services Task Force
This is a clinical practice guideline for women 35 or older who have not had a previous diagnosis of breast cancer. The guideline provides recommendations on the use of medication for breast-cancer risk reduction, specifically the selective estrogen receptor modulators tamoxifen and raloxifene, in women with a high or low risk of breast cancer. Outcomes of interest include breast cancer incidence (invasive, non-invasive, estrogen receptor positive, and estrogen receptor negative) and adverse effects of medication.

Supportive Care after Curative Treatment for Breast Cancer (Survivorship Care): Resource Allocations in Low- and Middle-income Countries

Year: 2013
AGREE II score: Unavailable
Developer organization: Breast Health Global Initiative
This guideline discusses supportive care of patients after they have received curative treatment for breast cancer. The guideline recommendations are geared towards patients in low- or middle-income countries. Recommendations are provided on health education, community awareness, and psychosocial patient-support after curative treatment, as well as management of survivorship issues including long-term complications, lifestyle modifications, and monitoring and documentation following curative treatment.

Breast Disease and Cancer: Diagnosis

Year: 2013
AGREE II score: Unavailable
Developer organization: Guidelines and Protocols Advisory Committee
This is a clinical practice guideline for women aged 19 or greater. The guideline reviews investigation of breast complaints and/or symptoms, diagnostic assessment stratified by age and risk, and management of common breast diseases. Referral criteria for genetic counselling is also discussed.

Breast Cancer in Women: Diagnosis, Treatment and Follow-up

Year: 2013
AGREE II score: Available
Developer organization: Belgian Health Care Knowledge Centre
A clinical practice guideline for female patients with breast cancer. The guideline examines management from diagnosis to treatment, with specific recommendations for multiple diagnoses and supportive treatments. Outcomes of interest include improved psychological outcomes with reduced time to breast reconstruction and improved progression free survival through treatment concurrent bevacizumab and chemotherapy.

Therapeutic Use of Myeloid Growth Factors for Chemotherapy-Induced Neutropenia in High Risk and Intermediate Risk Patients

Year: 2013
AGREE II score: Unavailable
Developer organization: Eastern Health
This is a clinical practice guideline for patients who are receiving systemic therapy for solid tumors, lymphoma and non-myeloid malignancies, and that are deemed at increased risk for developing febrile neutropenia as a result of myelosuppression. The guideline reviews the therapeutic use of myeloid growth factors (granulocyte-colony stimulating factors (G-CSFs), filgrastim and pegfilgrastim) in the prevention of chemotherapy induced neutropenia (CIN) according to patient risk for developing CIN.

Use of Pharmacologic Interventions for Breast Cancer Risk Reduction: American Society of Clinical Oncology Clinical Practice Guideline

Year: 2013
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
This clinical practice guideline provides recommendations on pharmacologic interventions for breast cancer risk reduction in women with no personal history of breast cancer who are at increased risk of developing the disease. Tamoxifen, raloxifene, arzoxifene, lasofoxifene, exemestane, and anastrozole are examined as chemoprevention agents. Outcomes of interest include incidence of invasive and noninvasive breast cancer (including ductal carcinoma in situ), breast cancer–specific mortality, overall mortality, net health benefits, quality of life, and adverse events.

Guidelines for Breast, Cervical and Colorectal Cancer Screening

Year: 2013
AGREE II score: Unavailable
Developer organization: CancerCare Manitoba
This guideline provides screening recommendations for breast, cervical, and colorectal cancer, based on age and risk factors. Management of test results including mammography, cytology, occult blood test (FOBT) and colonoscopy are discussed, and potential benefits and harms are reviewed. Other testing procedures include ultrasound, stereotactic core biopsy, colposcopy, endocervical curettage, endometrial biopsy, flexible sigmoidoscopy, and colonoscopy.

Common Breast Problems

Year: 2013
AGREE II score: Unavailable
Developer organization: University of Michigan Health System
This is a clinical practice guideline for adults aged 18 and over. The guideline reviews appropriate management and referral of patients presenting with common breast problems, including palpable mass or asymmetric thickening/nodularity on clinical exam, inflammation and other skin changes, breast pain with negative physical exam, and nipple discharge without abnormal exam findings. Management of special populations including pregnant women, men, and patients with augmented breasts, is also discussed. Outcomes of interest include sensitivity, specificity, and positive predictive value of diagnostic tests, and incidence of breast cancer.

Breast Reconstruction Following Prophylactic or Therapeutic Mastectomy for Breast Cancer

Year: 2013
AGREE II score: Available
Developer organization: Alberta Health Services
This is a clinical practice guideline for adult women who are candidates for mastectomy, either for the treatment of breast cancer or for the prophylaxis of breast cancer in patients at high genetic risk. The guideline reviews eligibility for post-mastectomy breast reconstruction and provides recommendations on type and timing of reconstruction after review of the benefits and risks. Post-breast reconstruction surveillance is also reviewed. Outcomes of interest include post-reconstruction complications (short and long term), quality of life, local recurrence, failure rate, cost effectiveness, and aesthetic outcomes.

Evidence-Based Clinical Practice Guideline: Breast Reconstruction with Expanders and Implants

Year: 2013
AGREE II score: Available
Developer organization: American Society of Plastic Surgeons
A clinical practice guideline for patients who have undergone breast cancer treatment, mastectomy, and breast reconstruction. The guideline examines risk factors, optimal timing, and follow-up screening recommendations. Outcomes of interest include improved local control and antibiotic prophylaxis.

Recommendations for Breast Cancer Surveillance for Female Survivors of Childhood, Adolescent, and Young Adult Cancer Given Chest Radiation

Year: 2013
AGREE II score: Available
Developer organization: International Late Effects of Childhood Cancer Guideline Harmonization Group
This is a clinical practice guideline for breast cancer surveillance for female survivors of childhood, adolescent, and young adult (CAYA) cancer given chest radiation. The guideline examines the risk survivors of CAYA cancer of premature morbidity and mortality due to previous cancer treatment. Outcomes of interest include surveillance, detection, and follow-up.

Supportive and Palliative Care for Metastatic Breast Cancer: Resource Allocations in Low- and Middle-income Countries

Year: 2013
AGREE II score: Unavailable
Developer organization: Breast Health Global Initiative
This clinical practice guideline discusses palliative and supportive care of patients with metastatic breast cancer. Specifically the guideline examines resource allocations for those patients in low- or middle income countries. Health systems resource allocations including education (for both health professionals and patients and families), palliative care models, and diagnostic testing are discussed. Additionally, supportive care recommendations are provided for metastatic disease management, and palliative care recommendations are discussed including pain management and psychosocial and spiritual aspects of care.

Revised Guidelines for the Clinical Management of Lynch Syndrome (HNPCC): Recommendations by a Group of European Experts

Year: 2013
AGREE II score: Unavailable
Developer organization: Mallorca Group
This is a clinical practice guideline regarding the clinical management of Lynch syndrome (LS) (previously referred to as hereditary non-polyposis colorectal cancer; HNPCC). The guideline looks at improving the identification of LS, optimal surveillance protocols for various cancers, the role of prophylactic hysterectomy with or without oophorectomy, and appropriate surgical treatment for CRC. Other topics of discussion include the influence of lifestyle and environmental factors on the development of CRC in LS, the role of aspirin in the management of LS, prenatal diagnosis (PND) and preimplantation genetic diagnosis (PGD) in LS, and the psychosocial implications of genetic testing and surveillance.

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

Year: 2013
AGREE II score: Unavailable
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for human epidermal growth factor receptor 2 testing in breast cancer. The guideline examines testing and results follow up for oncologists and pathologists in the United States. Outcomes of interest include optimal performance and reporting of assays, and improved education for providers.

Treatment of Primary Breast Cancer: A National Clinical Guideline

Year: 2013
AGREE II score: Available
Developer organization: Scottish Intercollegiate Guidelines Network
This is a clinical practice guideline for adult patients with primary breast cancer. The guideline reviews treatment options for operable early breast cancer, including surgery, chemotherapy, radiotherapy, endocrine therapy and other therapies such as biological therapy. Outcomes of interest include recurrence rate, survival, treatment morbidity and quality of life.

Familial breast cancer: Classification and Care of People at Risk of Familial Breast Cancer and Management of Breast Cancer and Related Risks in People with a Family History of Breast Cancer

Year: 2013
AGREE II score: Available
Developer organization: National Institute for Health and Care Excellence
This is a clinical practice guideline for male and female adults without breast cancer who are at risk for developing breast cancer because of a family history of breast, ovarian or a related cancer, or for male and female adults with a diagnosis of breast cancer and a family history of breast, ovarian, or related cancers. The guideline provides recommendations on genetic testing thresholds, and strategies for surveillance, risk reduction and treatment. Outcomes of interest include incidence of familial breast cancer, mortality from breast cancer, health related quality of life, and clinical and cost effectiveness of interventions.

Management of Elderly Patients with Breast Cancer: Updated Recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA)

Year: 2012
AGREE II score: Unavailable
Developer organization: International Society of Geriatric Oncology (SIOG)
A clinical practice guideline for the management of breast cancer in elderly individuals. The guideline examines differences in screening and treatment taking into account risk factors associated with elderly women, and comparisons are made to 2007 recommendations. Drug and safety compliance and male breast cancer are also considered.

National Breast Cancer Screening Clinical Practice Guideline

Year: 2012
AGREE II score: Available
Developer organization: Kaiser Permanente
A clinical practice guideline for the screening of women for breast cancer who are asymptomatic. This guideline examines diagnostic and screening procedures when risk factors are and are not present. Potential risk factors are enumerated and recommendations are made based on age and covariants. Outcomes include risk estimates, over- and under-diagnosis harms, and screening effectiveness.

Prevention and Treatment of Rash in Patients Treated with EGFR Inhibitor Therapies

Year: 2012
AGREE II score: Available
Developer organization: Alberta Health Services
This is a clinical practice guideline for adult patients with advanced non-small cell lung cancer, colorectal cancer, head/neck cancer, or breast cancer, that is treated with the epidermal growth factor receptor (EGFR) inhibitors cetuximab, erlotinib, gefitinib, panitumumab, or lapatinib, either alone or in combination with other treatments. The guideline examines the prevention and management of a papulopustular rash that commonly develops as a side effect of EGFR inhibitor therapy. Topics of discussion include prevention and prophylactic treatment of rash, clinical management, and supportive care. Outcomes of interest include rash severity, rate of recurrence, and response to treatment.

Cancer and Contraception

Year: 2012
AGREE II score: Unavailable
Developer organization: Society of Family Planning
This is a clinical practice guideline for reproductive-aged women who have received diagnosis of or treatment for breast cancer. The guideline discusses post-treatment fertility and provides recommendations on specific contraceptive methods depending on factors such as tumour type and cancer treatment side effects. Outcomes of interest include adverse affects and mortality.

Sentinel Lymph Node Biopsy and Axillary Node Dissection in Early Stage Breast Cancer

Year: 2012
AGREE II score: Available
Developer organization: Alberta Health Services
A clinical practice and professional guideline that seeks to establish a standard of care in Alberta for the management of axillary nodes in patients with newly diagnosed, early-stage breast cancer. The guideline compares sentinel lymph node biopsy (SLNB) with axillary lymph node dissection (ALND) for axillary staging, and provides recommendations for management of positive biopsy results. Technical and operational considerations are also discussed. Outcomes of interest include false-negative rates and survival.

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

Year: 2012
AGREE II score: Available
Developer organization: Cancer Care Ontario
This is a clinical practice guideline for women at very high risk of breast cancer, with 'very high risk' defined as: a known mutation in BRCA1, BRCA2 or other gene predisposing to a markedly elevated breast cancer risk; an untested first-degree relative of a carrier of such a gene mutation; family history consistent with a hereditary breast cancer syndrome and estimated personal lifetime cancer risk >25%; a high-risk marker on prior biopsy (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ [LCIS]); and/or radiation therapy to chest (before age 30 and at least eight years previous). The guideline discusses the use of magnetic resonance imaging (MRI) in conjunction with standard screening (mammography). Outcomes of interest include sensitivity, specificity, positive or negative predictive value, accuracy, time to diagnosis, tumour stage information (size, proportion DCIS, etc.), or improvement in patient outcome (response or survival).

Hormonal Treatment of In-Situ Breast Carcinoma

Year: 2012
AGREE II score: Unavailable
Developer organization: Eastern Health
A clinical practice guideline for the hormonal treatment of ductal carcinoma in situ. The guideline examines the use of tamoxifen for patients with ductal carcinoma in situ or lobular carcinoma in situ, and provides a recommended treatment plan.

Breast Cancer Follow-up and Management After Primary Treatment: American Society of Clinical Oncology Clinical Practice Guideline Update

Year: 2012
AGREE II score: Available
Developer organization: American Society of Clinical Oncology
A clinical practice guideline for breast cancer patients who have completed primary curative therapy. The guideline examines management and follow-up of breast cancer screening and provides recommendations for testing options and monitoring frequency. Coordination of care, breast imaging comparisons, and patient self-examination counseling are also discussed. Outcomes of interest include survival (overall and disease-free), quality of life, toxicity reduction and cost effectiveness.

Breast Cancer Treatment Guidelines

Year: 2012
AGREE II score: Unavailable
Developer organization: Saskatchewan Cancer Agency
A clinical practice guideline for the screening and treatment of primary, locally recurrent, and metastatic breast cancer. The guideline identifies individuals requiring screening, and offers treatment and follow up options for multiple procedures and therapies. Outcomes of interest include reduced mortality and eliminating unnecessary lab work.

Bone Health in Patients with Breast Cancer

Year: 2012
AGREE II score: Available
Developer organization: Alberta Health Services
A clinical practice guideline for breast cancer patients with bone metastases or at risk for induced bone loss. The guideline examines the use of bone-modifying agents and their administration with special considerations given to contraindicated medications and additional risk factors. Outcomes of interest include treatment efficacy, recurrence, and survival.

Indications for Use of Breast Magnetic Resonance Imaging (MRI)

Year: 2011
AGREE II score: Unavailable
Developer organization: Eastern Health
A clinical practice guideline for the use of MRI in breast cancer screening for patients who have hereditary risk, or have had previous radiation. The guideline examines indications and contraindications for breast MRI in screening, assessment, evaluation of treatment, and follow up. Outcomes of interest include MRI sensitivity and specificity.

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

Year: 2011
AGREE II score: Unavailable
Developer organization: Eastern Health
A clinical practice guideline for women at high risk for hereditary breast cancer. The guideline examines the efficacy of breast magnetic resonance imaging and recommends screening intervals. Outcomes of interest include improved hereditary screening, reduced mortality through early screening, and reduced false positives.

Recommendations for Use of Immediate Breast Reconstruction in Early-Stage Breast Cancer

Year: 2011
AGREE II score: Unavailable
Developer organization: Eastern Health
A clinical practice guideline for immediate breast reconstruction in women with early stage breast cancer. The guideline examines the oncological safety of immediate reconstruction based on recurrence, risk of delay in adjuvant chemotherapy, and complication rates. The disadvantages of reconstruction before radiation therapy are also discussed.

Chemoprevention of Breast Cancer in High Risk Patients

Year: 2011
AGREE II score: Unavailable
Developer organization: Eastern Health
This is a clinical practice guideline for managing patients at high risk for breast cancer. The guideline examines potential chemopreventative treatments, specifically hormonal treatments, for all premenopausal patients ≥ 35 years of age and postmenopausal patients who are deemed high risk for possible breast cancer. Outcomes of interest include risk of recurrence and treatment side effects.

Staging of Primary Breast Cancer

Year: 2011
AGREE II score: Unavailable
Developer organization: Eastern Health
A clinical practice guideline for asymptomatic patients with recently diagnosed primary breast cancer who have already undergone surgical resection. Recommendations are provided for staging investigations, and procedures including bilateral mammography, biopsy, ultrasound, and MRI are discussed.