The European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO) have put out new guidelines on treating advanced-stage breast cancer.
Advanced breast cancer (ABC) is a treatable but still generally incurable disease. The goals of care are to optimize both length and quality of life. In spite of all the advances, median overall survival of patients with ABC is still only 2–3 years, although the range is wide, and survival may be longer for patients treated in specialized institutions. Implementation of current knowledge is highly variable among countries and within each country.
Key overall recommendations by the 2nd International Consensus Conference for Advanced Breast Cancer (ABC2) are:
- All people diagnosed with advanced-stage breast cancer should be offered comprehensive, culturally sensitive, up-to-date, and easy-to-understand information about the disease and its management.
- Specialized oncology nurses – if possible, specialized breast nurses – should be part of the team treating people with advanced-stage breast cancer. In some countries, this a physician assistant or other healthcare professional may serve in this role.
- Doctors should use standardized forms/questionnaires for patients to report their symptoms and treatment side effects. The forms should be user-friendly and will allow doctors to better monitor patients’ quality of life and encourage better communication between doctors and patients.
- The age of person shouldn’t be a reason to avoid certain treatments (in older people) or to over-treat (in younger people).
The guidelines also include many specific recommendations for treating and managing specific types of advanced-stage breast cancer, including:
- inoperable locally advanced, non-inflammatory breast cancer
- inoperable locally advanced, inflammatory breast cancer
- metastatic triple-negative breast cancer caused by an abnormal BRCA1 or BRCA2 gene
- metastatic hormone-receptor-positive disease that is resistant to hormonal therapy caused by an abnormal BRCA1 or BRCA2 gene
- male advanced-stage breast cancer
- estrogen-receptor-positive, HER2-negative advanced-stage disease
- HER2-positive advanced-stage breast cancer
- HER2-negative advanced-stage breast cancer
The guideline panel also said much more research is needed to answer questions about four situations:
- breast cancer that has spread to the liver, chest cavity just outside the lungs, or skin
- HER2-positive breast cancer that comes back during or after Herceptin treatment
- surgery to remove the primary cancer in people with metastatic disease at diagnosis
- the role of aromatase inhibitors in treating advanced-stage male breast cancer
If you’ve been diagnosed with advanced-stage breast cancer, it’s reassuring to know that these guidelines outline many treatment options. If one treatment stops working, there are others you can try. If you’re willing to participate in a clinical trial, you may have even more options available. Together, you and your doctor can determine the best treatments for you.
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