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6.1 Introduction

Revised November 2017

A diagnosis of breast cancer requires patients and their caregivers to make a number of important decisions during the course of the disease. Surgery, systemic therapy, and radiotherapy are important treatments that optimize local, regional, and systemic control of the disease and optimize quality of life for patients with breast cancer. Multi-disciplinary care is an important resource that can aid in making these difficult decisions.

The mainstay of definitive treatment among patients with non-metastatic invasive and insitu breast cancer is surgical resection of the breast cancer, with consideration of neoadjuvant or adjuvant therapy. Those patients with inoperable, non-metastatic breast cancer may potentially be cured by neoadjuvant therapy, possibly followed by surgery. Patients with either recurrent or metastatic breast cancer may benefit significantly from treatment, with the primary goal of optimizing quality of life for those patients.   

Weekly conferences are held (Tuesday AM at the Vancouver Island Cancer Centre; Friday PM at the Vancouver Cancer Centre; Friday PM at the Cancer Centre for the Southern Interior, Monday at noon at the Fraser Valley Cancer Centre and Abbotsford Cancer Centre) to discuss the multi-disciplinary management of patients. Diagnostic radiologists, medical oncologists, pathologists, radiation oncologists and surgeons typically attend these conferences. The clinical history, physical examination, pathology slides and diagnostic imaging studies are reviewed and management options are discussed. Family physicians and surgeons are welcome to attend these conferences.

Patients with breast cancer should be supported in their decision-making about what treatment pathway is best for them. There are a number of online resources, including a Patient Information Kit, that we encourage patients to access. The BC Cancer library has videos, pamphlets and books for loan available to patients provincially - call 604-675-8001 or 1-888-675-8001, local 8001. See also BC Cancer Centres and Clinics and information for patients and the public.

The information in this section of the Cancer Management Guidelines is our current approach to patients with breast cancer. It is not intended to be a comprehensive manual on breast cancer and its treatments nor is it intended to imply that the approach given here is the only acceptable approach. 

Referral information for the new patient visit to BC Cancer

People with a suspected diagnosis of breast cancer should undergo percutaneous core biopsy , to confirm the pathology. This may be facilitated by the patient’s family physician in consultation with a surgeon.
Patients with a new diagnosis of non-metastatic breast cancer should be referred initially to a surgeon with experience in breast cancer surgery for assessment regarding operability and discussion of surgical options.  

Most commonly, women with operable breast cancer are referred to BC Cancer by their surgeon after their definitive breast +/- axillary surgery, when prognostic information from their surgery is available to guide discussions about adjuvant treatment.  Women with operable breast cancer who have difficulty making decisions about what type of surgery they would like to pursue after discussion and assessment by the surgeon can be referred to BC Cancer in the preoperative setting. 

Women with inoperable, locally advanced disease or women being considered for neo-adjuvant therapy should be referred to BC Cancer for assessment and management as soon as possible.  Women with metastatic breast cancer should also be referred to BC Cancer for assessment and management as soon as possible, as long as their performance status is sufficient to allow them to be assessed at BC Cancer.

SOURCE: 6.1 Introduction ( )
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