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. 2024 Nov 15;31(11):7226-7243.
doi: 10.3390/curroncol31110533.

Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for Clinical Staging of Patients Newly Diagnosed with Breast Cancer

Jeffrey Q Cao  1 , Brae Surgeoner  2 , Mita Manna  3 , Jean-François Boileau  4 , Karen A Gelmon  5 , Muriel Brackstone  6 , Christine Brezden-Masley  7 , Katarzyna J Jerzak  8 , Ipshita Prakash  4 , Sandeep Sehdev  9 , Stephanie M Wong  10 , Nathaniel Bouganim  10 , David W Cescon  11 , Stephen Chia  12 , Ian S Dayes  13 , Anil Abraham Joy  14 , Jan-Willem Henning  1
Affiliations

Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for Clinical Staging of Patients Newly Diagnosed with Breast Cancer

Jeffrey Q Cao et al. Curr Oncol. .

Abstract

The accurate staging of breast cancer is fundamental for guiding treatment decisions and predicting patient outcomes. However, there can be considerable variation in routine clinical practice based on individual interpretation of guidelines and depending on the healthcare provider initially involved in working up patients newly diagnosed with breast cancer, ranging from primary care providers, triage nurses, surgeons, and/or oncologists. The optimal approach for clinical staging, particularly in asymptomatic patients presenting with intermediate-risk disease, remains a topic of dialogue among clinicians. Given this area of uncertainty, the Research Excellence, Active Leadership (REAL) Canadian Breast Cancer Alliance conducted a modified Delphi process to assess the level of agreement among Canadian expert clinicians on various staging recommendations. In total, 20 items were drafted covering staging based on biological status, the utilization of localization clips, both for the axilla during diagnosis and primary surgical site for margins and radiation therapy planning, and the use of advanced imaging for the investigation of distant metastases. Overall, the consensus threshold among all participants (i.e., ≥75% agreement) was reached in 20/20 items. Differences in clinical practice and recent findings from the literature are provided in the discussion. These consensus recommendations are meant to help standardize breast cancer staging practices in Canada, ensuring accurate diagnosis and optimal treatment planning.

Keywords: REAL Alliance; breast cancer; recommendations; staging.

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Conflict of interest statement

J.-F.B.: Honoraria—Roche, Genomic Health, NanoString Technologies, Pfizer, Lilly, Novartis, Merck, and AstraZeneca. Speaker bureau/honoraria—Roche, Novartis, Genomic Health, Pfizer, Allergan, Merck, and AstraZeneca. Grants/research support—Institution received research funding (institution PI): Roche, Novartis, Pfizer, AbbVie, Merck, RNA Diagnostics Inc., Lilly, Bristol Myers Squibb, Genomic Health, and AstraZeneca. Other—Steering committee: MAC.39 (CCTG) and DESTINY BREAST-11 (AstraZeneca); N.B.: Advisory boards—Novartis, AstraZeneca. Speaker bureau/honoraria—Sanofi, Novartis, Lilly, Merck, Knight, and Astra Zeneca. Grants/research support—McGill University. Other—Merck, Astra Zeneca, Novartis; M.B.: No conflict of interest to declare; C.B.-M.: Honoraria—Amgen, Astellas, Biogene, Astra Zeneca, BMS, Rli Lolly, Gilead Sciences, Hoffman La-Roche, Knight, Merck, Novartis, and Pfizer. Speaker bureau/honoraria—Amgen, Astellas, Biogene, Astra Zeneca, BMS, Rli Lolly, Gilead Sciences, Hoffman La-Roche, Knight, Merck, Novartis, and Pfizer. Grants/research support—Astra Zeneca, Astellas, Pfizer, Novartis, and Gilead Sciences; J.C.: Speaker bureau/honoraria—Roche, Pfizer, Novartis, AstraZeneca, Well Doc Alberta, Merck, La Roche-Posay, Knight, Seagen, Oncology Education, and Gilead. Grants/research support—CIHR; D.W.C.: Advisory boards—AstraZeneca, Daiichi Sankyo, Gilead, GlaxoSmithKline, Inflex, Inivata/NeoGenomics, Lilly, Merck, Novartis, Pfizer, Roche, and Saga. Grants/research support: AstraZeneca, Guardant Health, Gilead, GlaxoSmithKline, Grail, Inivata/NeoGenomics, Knight, Merck, Pfizer, ProteinQure, Roche, and SAGA; S.C.: Advisory boards—Novartis, Hoffmann LaRoche, Pfizer, Eli Lilly, AstraZeneca, Amgen, Gilead, Merck, and Daichi Sanyko. Speaker bureau/honoraria—Novartis, Hoffmann LaRoche, Pfizer, Eli Lilly, AstraZeneca, Amgen, Gilead, Merck, and Daichi Sanyko. Grants/research support—Novartis, Hoffmann LaRoche, Pfizer, Genomic Health (Exact Sciences), AstraZeneca, Genentech, Celgene, Amgen, BMS, Merck, Sanofi, PUMA, and Gilead; K.A.G.: Honoraria—Novartis, Merck, Celuity, Astra Zeneca, Eli Lilly, Pfizer, Gilead, Seagan, and City of Hope. Speaker bureau/honoraria—Merck, AstraZeneca, CBCN, and Novartis. Grants/research support—CIHR, McGill, BMS, and Pfizer. Other—AstraZeneca, City of Hope Hospital, IDMC participation, Parexel, and Pfizer; J.-W.H.: Advisory boards—AstraZeneca, Eli Lilly, Gilead Sciences, Novartis, Pfizer, and Seagan. Speaker bureau/honoraria—AstraZeneca, Eli Lilly, Gilead Sciences, Novartis, Pfizer, Seagan, and University of Toronto. Grants/research support—AstraZeneca, Pfizer, ReThink Breast Cancer, and CIHR; K.J.: Advisory boards—Amgen, AstraZeneca, Apo Biologix, Daiichy Sanchyo, Eli Lilly, Esai, Genomic Health, Gilead Sciences, Knight Therapeutics, Merck, Myriad Genetics Inc., Pfizer, Roche, Seagen, Novartis, and Organon. Speaker bureau/honoraria—Amgen, AstraZeneca, Apo Biologix, Daiichy Sanchyo, Eli Lilly, Esai, Genomic Health, Gilead Sciences, Knight Therapeutics, Merck, Myriad Genetics Inc., Pfizer, Roche, Seagen, Novartis, and Organon. Grants/research support—Astra Zeneca, Eli Lilly, and Seagen; A.A.J.: Advisory boards—AstraZeneca, BMS, DS, Gilead, Eli Lilly, Merck, No-vartis, Pfizer, and Roche; M.M.: Advisory boards—Advanced Accelerator Applications, AstraZeneca, Eli Lilly, Gilead Sciences, Ipsen, Knight Therapeutics, Novartis, Pfizer, Daiichi Sankyo, and Roche. Speaker bureau/honoraria—McGill University, AstraZeneca, Bristol, Myers Squibb, Eli Lilly, Gilead Sciences, Knight Therapeutics, Merck, Novartis, and Pfizer. Grants/research support—AstraZeneca, Royal University Hospital Women Leading Philanthropy Grant; I.P.: Advisory boards—Prosigna. Speaker bureau/honoraria—Roche; S.S.: Advisory boards—Roche, Novartis, Lilly, Pfizer, BMS, Merck, AstraZeneca, Gilead, and Abbvie. Speaker bureau/honoraria—Roche, Novartis, Lilly, Pfizer, BMS, Merck, AstraZeneca, Helsinn, Knight Pharma, Gilead, Viatris, Seagen, Abbvie, and Juniper; S.M.W.: Advisory boards—AstraZeneca and Merck. Speaker bureau/honoraria—Merck. Grant/Research Support—Cancer Research Society.

Figures

Figure 1
Figure 1
Algorithm for Staging Investigations for Patients Newly Diagnosed with Breast Cancer without Signs and/or Symptoms of Distant Metastases. REAL Alliance overall recommendation for imaging of distant metastasis based on anatomic stage of disease, local regional workup, and timing consideration for imaging workup. (*) Endorsed recommendation from the Canadian Association of Radiologists’ guideline benchmarks for benchmark wait times [89].
See this image and copyright information in PMC

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