Clinical practice guidelines for the management and support of younger women with breast cancer

Guidelines for the treatment of breast cancer.
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Ann
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Postby Ann » Wed Jun 13, 2007 4:29 pm

Thanks Janine,
This is very timely given the concerns expressed in the forum today about girls being told they are too young for bc,
Ann
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Clinical practice guidelines for the management and support of younger women with breast cancer

Postby Janine » Wed Jun 13, 2007 1:51 am

[From the , publications. These Clinical Practice Guidelines can give an indication of how your medical team is thinking. This guideline is current but you'll notice some of the content may be a little dated.]


Prepared by the National Breast Cancer Centre
Funded by the Department of Health and Ageing
A National Health Priority Initiative
Approved by the NHMRC
on 27 November 2003
Australian Government
National Health and Medical Research Council

"Synopsis of publication:
This externally developed document provides information assisting younger women and their doctors in making decisions about all aspects of breast cancer care."



Younger age has been associated with physician delay in referral for investigation of breast symptoms. For this reason, young women presenting with breast symptoms should be evaluated by means of the triple test approach to exclude or establish a diagnosis of cancer.

Assessment of emotional concerns of younger women at diagnosis of breast cancer ensures early identification of distress so that appropriate interventions can be offered.

Radiotherapy after breast conserving surgery is recommended as it significantly reduces the risk of local recurrence.

For younger women, treatment with radiotherapy should also include a boost of radiation to the tumour bed, which further halves the local recurrence rate.

Clinicians should advise younger women that the benefit of chemotherapy is greater the younger the woman’s age. Chemotherapy will reduce the risk of recurrence by about one-fifth in women aged 60 to 69 years, but by nearly two-fifths in women under the age of 40.

Younger women with hormone receptor positive tumours should be advised that disease-free survival is significantly better when chemotherapy disrupts ovarian function, whether temporarily or permanently.

Endocrine therapy is recommended for all women aged 35 years or younger who have hormone receptor positive tumours, irrespective of whether or not they receive chemotherapy.

Combined endocrine treatment (LHRH agonist plus tamoxifen) is superior to LHRH agonist treatment alone in premenopausal women with advanced breast cancer in terms of length of survival.

Younger women should be advised about the relative effectiveness and safety of different treatments for menopausal symptoms resulting from chemotherapy or endocrine therapy.

Induced ovarian failure is an outcome of chemotherapy treatment for some younger women, resulting in infertility and onset of menopausal symptoms.

Clinicians should openly discuss fertility before treatment, and outline the probability of menopause based on the woman’s age and treatment regimen.

Women who wish to consider childbearing after treatment should be offered referral to a specialist with expertise in fertility treatment prior to the commencement of treatment.

Premenopausal women should be informed that their decision to have a child subsequent to a breast cancer diagnosis will not, as far as current evidence indicates, alter their risk of recurrence or overall survival.

Younger women, and indeed those of all ages, should be informed that moderate exercise has the potential to reduce fatigue and improve emotional wellbeing, even during radiotherapy or chemotherapy."
Janine


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