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The National Comprehensive Cancer Network (NCCN), an organization of 19 leading cancer care centers in the United States, updated its Breast Cancer Clinical Practice Guidelines in December 2005 to reflect recent advances in breast cancer treatment. The guidelines are meant to provide direction for healthcare professionals who treat women with breast cancer. The updated guidelines cover several new areas in breast cancer research. For example, the NCCN now recommends that clinicians take into account hormone receptor status (i.e., whether a patient's cancer is dependent upon estrogen) when determining breast cancer treatment options. The guidelines also provide guidance to clinicians on the use of new breast cancer drug therapies. According to the NCCN, its Clinical Practice Guidelines in Oncology are "developed and updated through a consensus-driven process with explicit review of the scientific evidence by multidisciplinary panels of expert physicians from NCCN institutions." Click here for a list of NCCN institutions. The updated version of the NCCN treatment guidelines now place a greater emphasis on adjuvant, or additional, therapies, such as chemotherapy or radiation, in conjunction with surgery, for patients with early-stage breast cancer. In particular, the NCCN recommends that clinicians consider factors such as whether breast cancer has spread to the nearby lymph nodes or whether it is "estrogen-receptor positive" or "estrogen-receptor negative." Estrogen-receptor positive cancers depend on the hormone estrogen for survival. It is important to weigh hormone status when considering breast cancer treatment because patients with estrogen-receptor positive breast cancer may be candidates for hormonal therapies, such as the drug tamoxifen. Another factor the NCCN guidelines recommend that clinicians consider when weighing treatment options is HER2 status. HER2 (human epidermal growth factor receptor 2) is a protein found on the surface of cells that, when functioning normally, has been found to be a key component in regulating cell growth. However, when the HER2 protein is altered, extra HER2 protein receptors may be produced. This over-expression of HER2 causes increased cell growth and reproduction, often resulting in more aggressive breast cancer cells. HER2 protein over-expression affects approximately 20% to 30% of breast cancer patients. Women with HER2 over-expression may not be as responsive to standard breast cancer treatments, including certain regimens of chemotherapy. Promising research shows that patients whose breast cancer tumors over-express the HER2 gene may benefit from the drug, Herceptin (generic name, trastuzumab). For example, the results of two clinical trials announced by the U.S. National Institutes of Health in 2005 showed that Herceptin, combined with chemotherapy, can significantly reduce the chances of a breast cancer recurrence in women with HER2 positive breast cancer. In terms of treating advanced breast cancer, the NCCN has expanded its guidelines of appropriate options. Based on recent research, drugs including paclitaxel (brand name, Taxol) plus bevacizumab (Avastin) and albumin-bound paclitaxel (Abraxane) have been added to the NCCN's recommendations. In addition to the newly updated clinician guidelines, the NCCN also updated its patient version of its Breast Cancer Treatment Guidelines in August 2005, in collaboration with the American Cancer Society. The patient guidelines translate the NCCN's guidelines into easy-to-understand language and include tools such as "decision trees" to aid patients in search of information about breast cancer treatment options.
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