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Protocols

Introduction
Table of Contents and associated protocol files (.pdfs)
Protocols - pages 1-34 (.pdf 402 KB)
Development Committee
Acknowledgements
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INTRODUCTION

In order to translate the breast cancer treatment guidelines (approved by the National Health and Medical Research Council—NHMRC) into changed practice the Westmead BCI has developed and published agreed Protocols, which will serve as a model for other breast centres being established in major teaching hospitals.

The Protocols are intended for use by specialists and trainees, and will be available on request to general practitioners. The Protocols are designed to provide information to assist decision-making and are based on the best information available at the time of publication.

The first edition of the Westmead Breast Cancer Institute (BCI) Clinical Treatment Protocols was developed as follows:

  1. A multidisciplinary clinical protocol committee with representatives from the three Area Health Services was established as a sub-committee of the Western Areas Breast Group (WABG).
  2. The draft protocols were sent to members of WABG residing in the region for comment and feedback (March 1998)
  3. The March 1998 WABG education session was dedicated to receiving written and verbal feedback on the draft protocols.
  4. The final protocols were developed after verbal and written feedback (December 1999).
  5. A pilot implementation version was distributed in June 2000.

The protocols will be evaluated and revised as required six months after first publication.

Audience: These protocols are intended for use by specialists and trainees, and will be available on request to general practitioners. The protocols have been informed by breast cancer treatment guidelines approved by the National Health Medical Research Council (NHMRC).

Disclaimer: The Westmead BCI clinical treatment protocols are designed to guide appropriate practice, to be followed only subject to the clinician’s judgement in each individual case.

The protocols are designed to provide information to assist decision-making and are based on the best information available at the time of publication.

It is important to realise that protocols cannot always account for individual variation among patients. They are not intended to supplant physicians’ judgement with respect to particular patients or special clinical situations and cannot be considered inclusive of all proper methods of care or exclusive of other treatments reasonably directed at obtaining the same results.

CONTENTS

PDF files are attached the first 34 pages of the protocols listed below. To receive a full set of Breast Cancer Treatment Protocols, see the order form.

Breaking bad news
Communication
Provision of information—general
Provision of information—specific
Familial aspects of breast cancer
International Breast Cancer Intervention Study (IBIS) Trial
BreastScreen Westmead
Criteria for diagnosis of breast cancer
Breast imaging reporting
Fine needle aspiration—cytology report
Localisation biopsy
  • Typical operating report
Pre-treatment investigations
TNM classification
Ductal carcinoma in situ
  • Pathology report
Paget’s disease of the nipple
Lobular carcinoma in situ
Early operable breast cancer
  • Breast conservation—surgery
  • Breast conservation—margins
  • Extensive intraductal component
  • Breast conservation—radiation
  • Complications of radiotherapy
  • Axillary nodal dissection
  • Typical operating report—wide local excision and axillary
  • Sample pathology request and operation record dissection
  • Lumpectomy worksheet—pathology report
  • Nodal radiation treatment
Breast conservation—outcomes
  • Local control & cosmesis
  • Cosmesis—patients’ perceptions
  • Complications—patients’ perceptions
  • Complications—clinicians’ assessments
Total mastectomy
  • Typical operating report
  • Pathology report
Post-mastectomy radiation therapy—indications
Prophylactic mastectomy
Adjuvant systemic therapy
  • Category 1: Lower risk
  • Category 2: Intermediate risk
  • Category 3: Higher risk
  • Complications
  • Antiemetics
Adjuvant therapy—surgical oophorectomy
Locally advanced breast cancer
Recurrent/metastatic breast cancer
  • Endocrine therapy
  • Chemotherapy
  • Important scenarios
Male breast cancer
Phyllodes tumour
Follow-up
Appendices
Appendix 1
  • Summary: Local recurrence according to treatment and pathological factor
Appendix 2
  • Frequency of axillary nodal metastases
Appendix 3
  • Local control post mastectomy
Appendix 4
  • Baseline prognosis without systemic therapy
Appendix 5
  • 10-year survival gains from adjuvant tamoxifen
  • 10-year survival gains from adjuvant chemotherapy
Bibliograp


©2001 Westmead Breast Cancer Institute

These protocols are copyright. Apart from copying permitted under the Copyright Act, neither this document nor any part of it may be reproduced in any form by any means.

Western Areas Breast Group

TREATMENT PROTOCOLS DEVELOPMENT COMMITTEE

South Western Sydney Area Health Service (SWSAHS)

Mr Tom Bonar, Surgeon (Chairman)
Dr Geoff Delaney, Radiation Oncologist
Dr Eugene Moylan, Medical Oncologist

Wentworth Area Health Service (WAHS)

Mr Pat Cregan, Surgeon
Dr Verity Ahern, Radiation Oncologist
Dr Nicholas Wilcken, Medical Oncologist

Western Sydney Area Health Service (WSAHS)

Mr Owen Ung, Surgeon
A/Prof. John Boyages, Radiation Oncologist
A/Prof. Paul Harnett, Medical Oncologist

Specialist Advisers

Dr Stephen Cahill, Radiology
A/Prof. Michael Bilous, Pathology
Dr Judy Kirk, Genetics

Editor in Chief

A/Prof. John Boyages, Executive Director, Westmead Breast Cancer Institute

Editors

Dr Boon Chua, Radiation Oncology Breast Fellow, Westmead Breast Cancer Institute
Ms Eleonore Fuchter, Clinical Program Manager, Westmead Breast Cancer Institute

Editorial Consultant

Dr Greg Heard, Principal Consultant, Nullegai Communications

ACKNOWLEDGMENTS

Cathie Lyons and Niranjala Hillyard provided administrative support for the preparation of this document.

An advanced draft of these protocols was distributed for review to cancer specialists across New South Wales. The following clinicians provided written feedback on a pilot ‘implementation version’ of these protocols:

  • Mr Pat Cregan, Breast, Endocrine and Endoscopic Surgeon
  • Dr Mary Dwyer, Radiation Oncologist
  • Dr Michael Back, Radiation Oncologist
  • Dr Judy Kirk, Familial Cancer Service
  • Dr Stuart B Porges, Rural Breast Surgeon
  • Dr Michael Frances, Radiation Oncologist
  • Prof. Paul Harnett, Medical Oncologist
  • Dr Peter Gough, Breast/General Surgeon, Queen Elizabeth Hospital, Kings Lynn, England
Last Updated on Tuesday, 09 February 2010 14:08