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Management of breast cancer in women: A national clinical guideline

The authors, Gary Stoneburner, from NIST and Alice Goguen and Alexis Feringa from Booz Allen Hamilton wish to express their thanks to their colleagues at both organizations who reviewed drafts of this document. In particular, Timothy Grance, Marianne Swanson, and Joan Hash from NIST and Debra L. Banning, Jeffrey Confer, Randall K. Ewell, and Waseem Mamlouk from Booz Allen provided valuable insights that contributed substantially to the technical content of this document. Moreover, we gratefully acknowledge and appreciate the many comments from the public and private sectors whose thoughtful and constructive comments improved the quality and utility of this publication | SI GN Scottish Intercollegiate Guidelines Network NHS Quality Improvement Scotland Management of breast cancer in women A national clinical guideline 1 Introduction 1 2 Diagnosis referral and investigation 2 3 Surgery 7 4 Radiotherapy 13 5 Systemic therapy 16 6 Psychological care 24 7 Follow up 29 8 Information for discussion with patients and carers 31 9 Development of the guideline 35 10 Implementation and audit 38 Abbreviations 40 Annexes 41 References 44 December 2005 COPIES OF ALL SIGN GUIDELINES ARE AVAILABLE ONLINE AT WWW.SIGN.AC.uk KEY TO EVIDENCE STATEMENTS AND GRADES OF RECOMMENDATIONS LEVELS OF EVIDENCE 1 High quality meta-analyses systematic reviews of randomised controlled trials RCTs or RCTs with a very low risk of bias 1 Well conducted meta-analyses systematic reviews of RCTs or RCTs with a low risk of bias 1 - Meta-analyses systematic reviews of RCTs or RCTs with a high risk of bias 2 High quality systematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal 2 - Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3 Non-analytic studies eg case reports case series 4 Expert opinion GRADES OF RECOMMENDATION Note The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation. A B C D At least one meta-analysis systematic review of RCTs or RCT rated as 1 and directly applicable to the target population or A body of evidence consisting principally of studies rated as 1 directly applicable to the target population and demonstrating overall consistency of results A body of evidence including .