• Breast Cancer Disease Site Group. Surgical management of early stage invasive breast cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Jan [online update]. 20 p. (Practice guideline; no. 1-1). [77 references]

• Women who are eligible for breast conservation therapy should be offered the choice of either breast conservation therapy with axillary dissection or modified radical mastectomy.
• Removal and pathological examination of level l and II axillary lymph nodes should be the standard practice in most cases of Stage I and II breast carcinoma.
• There is promising but limited evidence that is not as yet sufficient to support recommendations regarding sentinel lymph node biopsy alone. Patients should be encouraged to participate in clinical trials investigating this procedure. However, axillary dissection is the standard of care.

None provided

• In the surgical management of early-stage invasive breast cancer, eleven randomized controlled trials, four meta-analyses, and four guidelines comparing the effect of breast-conserving therapy versus mastectomy on overall survival or recurrence were identified and reviewed.
• In the surgical management of the axilla, six randomized controlled trials, one meta-analysis, two clinical practice guidelines on axillary dissection, and one randomized trial on axillary node sampling were identified and reviewed.
• One meta-analysis and one clinical practice guideline on sentinel lymph node biopsy were also included in this guideline report.
• In comparing quality-of-life in patients undergoing breast conservation therapy versus mastectomy, 13 papers reporting quality-of-life data from randomized trials, one systematic review, and one meta-analysis were identified.

• Breast Cancer Disease Site Group. Surgical management of early stage invasive breast cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Jan [online update]. 20 p. (Practice guideline; no. 1-1). [77 references]

Not applicable: The guideline was not adapted from another source.

1996 Feb 14 (revised January 2003)

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Practice Guidelines Initiative (PGI) is the main project of the Program in Evidence-based Care (PEBC), a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health.

Cancer Care Ontario, Ontario Ministry of Health and Long-Term Care

Provincial Breast Cancer Disease Site Group

Members of the Breast Cancer Disease Site Group disclosed potential conflict of interest information.

None available

This summary was completed by ECRI on January 5, 1999. The information was verified by the guideline developer as of February 22, 1999. This summary was updated by ECRI on April 12, 2002 and most recently on July 21, 2003. The most recent information was verified by the guideline developer as of August 6, 2003.