By New Zealand Guidelines Group
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Extra resources for Management of Early Breast Cancer
4% of all female registrations), with an age-standardised rate of 92 cases per 100,000 females. 2 The cumulative survival rate after adjusting for expected causes of death is approximately 82% after five years. 3 While the incidence of both female and male breast cancer is increasing in New Zealand,5 the female breast cancer mortality rate has reduced by 19% over the last decade, mirroring international trends. 5 times that of non-Mäori women. 2 Mäori women compared with non-Mäori women were more likely to be diagnosed with breast cancer and, after diagnosis, were two-thirds more likely to die as a result.
Information should be provided on an individually tailored basis with educational, cultural and ethnic factors taken into consideration. Different options are available to provide this information and the most Management of early breast cancer 7 Chapter 2: General principles of care appropriate method should be selected in discussion with the person with early breast cancer. Repetition of information through additional media or the presence of a support person may help retention of information.
0 further monitoring of bone density may not be necessary C A woman with early breast cancer at risk of bone mineral loss should be provided with appropriate advice for good bone health. C This includes, but is not limited to: • a healthy diet • cessation or continuing abstinence from smoking • maintenance of a healthy body mass index • regular exercise • calcium • adequate vitamin D levels xxiv Management of early breast cancer Summary Ductal carcinoma in situ Mastectomy compared with breast conserving surgery: ductal carcinoma in situ Recommendation Grade When making the choice between breast conserving surgery and mastectomy the following factors should be considered in discussion with the woman: C • ratio of the size of the tumour to the size of the breast and tumour location in terms of acceptable cosmesis • the presence of multifocal/multicentric disease or extensive malignant microcalcification on mammogram which cannot be adequately cleared with an acceptable cosmetic result with breast conserving surgery • potential contraindications to local radiotherapy (eg, previous radiotherapy at this site, connective tissue disease, severe heart and lung disease, pregnancy) • fitness for surgery • patient choice Margins of excision for breast conserving surgery: ductal carcinoma in situ Recommendations Grade Ductal carcinoma in situ (DCIS) extending up to a margin of excision requires further surgery – either wider excision or mastectomy to achieve clear margins in the absence of contraindications A Detailed pathological assessment of the distance of the in situ carcinoma from the margins should be made C A circumferential or radial margin of greater than or equal to 2 mm should be achieved where possible C For women with margin widths of less than 2 mm several factors should be considered in determining whether re-excision is required.
Management of Early Breast Cancer by New Zealand Guidelines Group