Result card

  • CUR14: How is the disease/health condition currently being managed?
English

How is the disease/health condition currently being managed?

Authors: Sarah Baggaley, Massimo Gion

Internal reviewers: Luciana Ballini, Aurora Llanos, Antonio Migliore, Claudia Wild

The information used for this section was from evidence-based guidelines and other HTAs. The responses from surveys sent to clinicians and healthcare agencies were also reviewed.

Usually, the first treatment option for invasive breast cancer is surgery to remove the tumour or breast and any involved lymph nodes. Following surgery, histological examination of the tissues removed during surgery provides prognostic information including tumour grade, nodal status and tumour size. Receptor status (e.g. ER, HER2) is also determined to predict the response to specific targeted therapies. Patient characteristics and these prognostic and predictive factors are considered by a breast cancer multidisciplinary team to assess the risk of breast cancer recurrence and determine a plan of treatment.

Most patients with early breast cancer will require treatment that involves adjuvant therapy in addition to surgery. Adjuvant therapy typically consists of radiotherapy (typically for individuals with large tumours or many involved lymph nodes), chemotherapy (for individuals at high risk of poor outcome) or endocrine therapy (for individuals with tumours that are ER+) and many patients will require a combination of these. The purpose of adjuvant systemic therapy is to reduce the risk of breast cancer recurring because circulating cancer cells (occult metastatic disease) can often go undetected at the time of diagnosis and, therefore, breast cancer can recur at a later date. Planning adjuvant therapy is complex and mostly dependent on clinical decisions, the risk of recurrence, patient choice, the availability of drugs or therapies, and the licensed indications and side-effect profiles of individual drugs or therapies {1, 2}. The availability of different drugs and therapies may vary between countries and local healthcare authorities.

One of the challenges associated with the management of breast cancer is the decision about whether or not to use adjuvant chemotherapy. The likelihood of breast cancer recurrence and death is less for individuals who receive adjuvant chemotherapy so many individuals with early-stage breast cancer are advised to undergo chemotherapy. However, chemotherapy can have severe adverse effects and not all individuals will benefit from receiving it. Some, especially those with small tumours, may remain free of breast cancer recurrence at 10 years without chemotherapy.  

There are a number of algorithms and decision making tools to help clinicians assess the risk of breast cancer recurrence {2}. The prognostic tests, uPA/PAI-1 [FEMTELLE], MammaPrint and Oncotype DX are used in some countries to detect known predictive genetic or protein markers to help clinicians predict the likelihood of breast cancer recurrence in women and to support the tailoring of treatment to the individual patient.

The responses from the surveys did not indicate that the current management of breast cancer is different to published guidelines although the surveys were primarily focussed on the use of the prognostic tests not on the management of breast cancer.

Important
Partially
Baggaley S, Gion M Result Card CUR14 In: Baggaley S, Gion M Health Problem and Current Use of the Technology In: Jefferson T, Vicari N, Raatz H [eds.]. Prognostic tests for breast cancer recurrence (uPA/PAI-1 [FEMTELLE], MammaPrint, Oncotype DX ) [Core HTA], Agenzia nationale per i servizi sanitari regionali (age.na.s), Italy ; 2013. [cited 7 February 2023]. Available from: http://corehta.info/ViewCover.aspx?id=113

References