Updated NCCN Guidelines for Breast Cancer Discourages Prophylactic Mastectomy in Women Other Than Those at High Risk

Updated NCCN Guidelines for Breast Cancer Discourages Prophylactic Mastectomy
in Women Other Than Those at High Risk

The removal of a noncancerous breast (prophylactic mastectomy) is generally
discouraged in women other than those at high risk as stated in the updated
National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in
Oncology(TM) for Breast Cancer. Other noteworthy updates to the NCCN
Guidelines include a new regimen for adjuvant chemotherapy in invasive breast
cancer and the option for women with clinically negative lymph nodes to avoid
a full axillary lymph node dissection.

FORT WASHINGTON, Pa., Oct. 28 /PRNewswire-USNewswire/ -- Despite a recent
study finding that an increasing number of women who had cancer in one breast
are opting to have the other breast removed, the National Comprehensive Cancer
Network (NCCN) Clinical Practice Guidelines in Oncology(TM) for Breast Cancer
discourages prophylactic mastectomy in women except for those considered high
risk. This recommendation is noted in the recently updated NCCN Guidelines for
Breast Cancer along with a new regimen for adjuvant chemotherapy and
recommendations for utilizing sentinel node mapping and excision in women with
clinically negative lymph nodes.

In the updated NCCN Guidelines, it states that prophylactic mastectomy (the
removal of a noncancerous breast) contralateral to a known unilateral breast
cancer is not recommended except as outlined in the NCCN Guidelines for
Genetics/Familial High-Risk Assessment: Breast and Ovarian and the NCCN
Guidelines for Breast Cancer Risk Reduction. When prophylactic mastectomy is
being considered, the NCCN Guidelines note that the small benefits must be
balanced with the risk of recurrent disease from the known breast cancer, the
psychological and social issues associated with bilateral mastectomy, and the
overall risks of contralateral mastectomy.

The practice of removing noncancerous breasts to reduce the risk or prevent
cancer has become increasingly common among women. A study recently published
in the journal Cancer found that among women who had cancer in one breast, the
number who opted to have the other breast removed, more than doubled from 1995
through 2005 in New York state. However, there is no data to demonstrate that
having prophylactic mastectomy actually improves survival.

The NCCN Guidelines Panel suggests that high-risk women considering a
prophylactic mastectomy should be evaluated by a multi-disciplinary team and
counseled on the risks of the procedure.

Perhaps the most clinically important update to the NCCN Guideline is the
removal of the recommendation for a full axillary lymph node dissection as an
option for women with clinically negative lymph nodes. The updated NCCN
Guidelines now recommend that women with stage one or two invasive breast
cancer with clinically negative lymph nodes, undergo sentinel node mapping and
excision provided they are being treated by a team of clinicians with
experience in sentinel node biopsy.

Sentinel node biopsy is a diagnostic procedure used to determine whether
breast cancer has metastasized to axillary lymph nodes (e.g., lymph nodes
under the arm). Sentinel node biopsy requires the removal of only a few lymph
nodes compared to a full axillary lymph node dissection, and may decrease the
risk of lymphedema and pain associated with surgery.

Another important update to the NCCN Guidelines is the addition of a new
regimen for adjuvant chemotherapy for invasive breast cancer. The NCCN
Guidelines now include FEC [fluorouracil (Adrucil(R), Pfizer Inc.) /
epirubicin (Ellence(R), Pfizer Inc.) / cyclophosphamide (Cytoxan(R),
Bristol-Myers Squibb Company)] followed by weekly paclitaxel (Taxol(R),
Bristol-Myers Squibb Company) as an option for adjuvant therapy, treatment
given after surgery.

Although the incidence of breast cancer has increased steadily in the United
States over the past few decades, breast cancer mortality appears to be
declining suggesting a benefit from early detection and more effective
treatment.

NCCN Clinical Practice Guidelines in Oncology(TM) are developed and updated
through an evidence-based process with explicit review of the scientific
evidence integrated with expert judgment by multidisciplinary panels of
physicians from NCCN Member Institutions. The most recent version of this and
all the NCCN Guidelines are available free of charge at NCCN.org.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of
21 of the world's leading cancer centers, is dedicated to improving the
quality and effectiveness of care provided to patients with cancer. Through
the leadership and expertise of clinical professionals at NCCN Member
Institutions, NCCN develops resources that present valuable information to the
numerous stakeholders in the health care delivery system. As the arbiter of
high-quality cancer care, NCCN promotes the importance of continuous quality
improvement and recognizes the significance of creating clinical practice
guidelines appropriate for use by patients, clinicians, and other health care
decision-makers. The primary goal of all NCCN initiatives is to improve the
quality, effectiveness, and efficiency of oncology practice so patients can
live better lives.

The NCCN Member Institutions are: City of Hope Comprehensive Cancer Center,
Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts
General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center,
Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer
Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson
Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney
Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H.
Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL;
Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer
Center & Research Institute, Tampa, FL; The Ohio State University
Comprehensive Cancer Center - James Cancer Hospital and Solove Research
Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman
Cancer Center at Barnes-Jewish Hospital and Washington University School of
Medicine, St. Louis, MO; St. Jude Children's Research Hospital/University of
Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center,
Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center,
Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San
Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor,
MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The
University of Texas
M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer
Center, Nashville, TN.

For more information, visit NCCN.org.

SOURCE National Comprehensive Cancer Network

Megan Martin, NCCN, +1-215-690-0576, martin@nccn.org