# Breast cancer (all types) Source: https://onco.cc/cancers/breast-cancer/ OnCo record `breast-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence. ## TL;DR Breast cancer is not one disease, and the result that decides which page you need is the receptor result: whether the cancer carries oestrogen and progesterone receptors, and whether it carries too much HER2. Those two answers give four boxes, not three, with a page for each. Grade and stage do not change which page you read; they change what happens on it. ## Summary Breast cancer arises from the milk ducts or lobules and is classified by the receptors on its cells: oestrogen and progesterone receptors, and HER2. Hormone receptor-positive, HER2-negative disease is treated with endocrine therapy and CDK4/6 inhibitors; HER2-positive disease with HER2 antibodies and antibody-drug conjugates; triple-negative disease with chemotherapy, immunotherapy and, for BRCA carriers, PARP inhibitors. Ductal carcinoma in situ is a precursor confined to the duct, and about one percent of cases occur in men. Screening mammography from around age 50, breast-conserving surgery with radiotherapy, sentinel node biopsy and genomic tests that spare chemotherapy are common to all types. Most patients present early and are cured. Metastatic disease is treated in successive lines rather than once, is controlled for years in many people, and is rarely cured; the subtype pages carry the sequence, the trials open in each line and the point at which a trial is a reasonable choice beside standard treatment. ## Fields - Kind: Cancer - Last checked: 2026-09-25 - Also known as: TCGA-BRCA; breast invasive carcinoma (TCGA BRCA cohort); Breast carcinoma; Carcinoma of the breast - Tags: parent-page - Group: breast - Burden: The commonest cancer in the world and in the UK. Worldwide there are 2,434,087 new breast cancers and 693,660 deaths a year, second for cases among all cancers and fourth for deaths (GLOBOCAN 2024). In the UK there are 59,413 new cases a year, about 59,000 in females and 420 in males, 15 percent of all cancers, and 11,200 deaths a year (Cancer Research UK). In England in 2022, 85 percent of cases with a known stage were stage I or II. - Subtypes: By receptor result, which is what chooses a treatment page: hormone receptor-positive and HER2-negative (70.1 percent of American cases with a known subtype), HER2-positive whatever the hormone receptors say (13.3 percent, of which 9.3 points are also hormone receptor-positive), and triple-negative (10.8 percent) (SEER 21, 2019 to 2023); By histological type, which the WHO classification decides: invasive carcinoma of no special type (the commonest by far), invasive lobular carcinoma (about 15 percent), and the special types, each with its own page; By whether the cancer has broken out of the duct or lobule: ductal carcinoma in situ and lobular carcinoma in situ are staged Tis and are not invasive cancer; Clinical entities that are defined by how they present rather than by histology: inflammatory breast cancer (staged T4d) and Paget disease of the nipple; Phyllodes tumour, which is not a carcinoma at all but a fibroepithelial tumour of the breast stroma - Biomarkers: Oestrogen and progesterone receptors; HER2 (including HER2-low); Ki-67 and grade; Genomic recurrence scores (Oncotype DX, MammaPrint); BRCA1/2 and other germline variants; PD-L1 (triple-negative); ESR1 and PIK3CA mutations (advanced hormone receptor-positive); Oestrogen receptor, reported as a percentage of stained invasive nuclei with an intensity, positive at 1 percent or more, with 1 to 10 percent reported separately as ER low positive (RCPath G148; ASCO/CAP 2020); Progesterone receptor, asked for by NICE NG101 1.3.3 on every invasive cancer but not a mandatory item of the UK pathology dataset, and used for prognosis and quality control rather than to predict endocrine benefit; HER2 by immunohistochemistry 0 to 3+, with reflex dual-probe in situ hybridisation for 2+ reporting the HER2 to chromosome 17 ratio, the HER2 copy number and the chromosome 17 copy number; 13 to 20 percent of early breast cancer is positive (RCPath G148); Nottingham grade, and the three component scores that make it, which are mandatory to record separately; Invasive tumour size and whole tumour size in millimetres, reported as two different numbers; Lymph node status, and whether it came from a sentinel node biopsy, which is written pN0(SN); Nottingham Prognostic Index from grade, node stage and size, and PREDICT, which NICE NG101 1.6.4 asks clinicians to use ## Sections of this record The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/breast-cancer/sections.json - Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/breast-cancer/#overview [18 subtypes, 7 state-of-the-art points] - Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/breast-cancer/#what-it-is [23 subtypes, 9 staging notes] - Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/breast-cancer/#finding-it [6 symptoms, 14 biomarkers] - Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/breast-cancer/#treating-it [24 settings, 8 decisions with options] - Trials and papers (own page): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/breast-cancer/evidence/ [128 trials, 475 trials in the subtypes, 16 key papers, 15 milestones] - Biology and targets (own page): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/breast-cancer/science/ [314 targets] - Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/breast-cancer/where-you-are/ [1 centre, 110 centres in the subtypes, 16 UK centres] - Decisions and support (own page): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/breast-cancer/living-with-it/ [59 questions, 4 red cards, 1 decision aid] - Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/breast-cancer/coming/ [3 medicines, 176 medicines in the subtypes, 128 trials, 10 open problems] - Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/breast-cancer/data/ [669 connected records, 10 notes] ## Standard of care - Early disease, all types: Breast-conserving surgery with radiotherapy or mastectomy, sentinel node biopsy, then treatment by receptor type on the subtype pages. ([HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/)) - Ductal carcinoma in situ: Surgery with or without radiotherapy and endocrine therapy; active surveillance under study. ([Ductal carcinoma in situ (DCIS)](https://onco.cc/cancers/ductal-carcinoma-in-situ/)) - Every invasive breast cancer, at diagnosis: Oestrogen receptor, progesterone receptor and HER2 assessed simultaneously on the diagnostic biopsy by quality-assured immunohistochemistry, reported quantitatively, with reflex in situ hybridisation for a HER2 score of 2+, and the results available at both the preoperative and the postoperative multidisciplinary meeting. The pathology report also carries the histological type, the Nottingham grade with its three component scores, the invasive and whole tumour size, the node stage and the margins. ([Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Core needle biopsy and fine-needle aspiration (FNA)](https://onco.cc/terms/core-needle-biopsy/), [FISH / ISH (in situ hybridisation)](https://onco.cc/terms/fish/), [How ER and PR are scored on a breast report (Allred score, H score, and why PR is not a UK core item)](https://onco.cc/terms/er-pr-scoring-breast/), [HER2 testing in the UK: reflex ISH, the ratio against the copy number, and where the UK differs from ASCO/CAP](https://onco.cc/terms/her2-testing-uk-breast/), [Nottingham grade (breast cancer grade 1, 2 and 3)](https://onco.cc/terms/nottingham-grade/)) - Staging and prognostic assessment: Ultrasound of the axilla with needle sampling of any abnormal node before treatment; MRI only where the extent is unclear, the breast is too dense to assess or a lobular cancer is being sized for breast-conserving surgery. Stage against UICC TNM 8, and put grade, node stage and size together in the Nottingham Prognostic Index and in PREDICT, which estimates the benefit of each adjuvant treatment. In advanced disease, contrast-enhanced CT of chest, abdomen and pelvis or FDG PET-CT. ([Ultrasound](https://onco.cc/technologies/ultrasound/), [MRI](https://onco.cc/technologies/mri/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage](https://onco.cc/terms/tnm-breast-cancer-editions/), [Nottingham Prognostic Index (NPI), and PREDICT](https://onco.cc/terms/nottingham-prognostic-index/), [Grade, stage and receptor status: three different things on one breast report](https://onco.cc/terms/grade-stage-receptor-breast/)) - At recurrence: Consider reassessing hormone receptor and HER2 status on a biopsy of the recurrence where a change in receptor status would change management, because conversion between the primary and a metastasis is common in both directions. ([Receptor conversion: when the receptors change between the primary and a recurrence](https://onco.cc/terms/receptor-conversion-breast/), [Core needle biopsy and fine-needle aspiration (FNA)](https://onco.cc/terms/core-needle-biopsy/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/)) - Surgery to the breast: conservation or mastectomy: Breast-conserving surgery with radiotherapy, or mastectomy, depending on the size of the tumour against the size of the breast, whether there is more than one tumour, whether radiotherapy is possible, and what the woman wants. Survival is the same either way and has been for twenty years: NSABP B-06 found a hazard ratio for death of 0.97 (0.83 to 1.14) for lumpectomy with irradiation against mastectomy, Milan I found death from any cause of 41.7 against 41.2 percent at twenty years, and EORTC 10801 found a hazard ratio of 1.11 (0.94 to 1.33) at a median 22.1 years. What differs is recurrence in the conserved breast, which is why radiotherapy goes with conservation. Oncoplastic techniques widen the range of tumours that can be conserved. ([NSABP B-06](https://onco.cc/trials/nsabp-b06/), [Milan I (quadrantectomy against radical mastectomy)](https://onco.cc/trials/milan-i/), [EORTC 10801](https://onco.cc/trials/eortc-10801/), [NSABP B-04](https://onco.cc/trials/nsabp-b04/), [Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Mastectomy](https://onco.cc/terms/mastectomy/), [Breast conservation or mastectomy](https://onco.cc/terms/breast-conserving-surgery-versus-mastectomy/), [Oncoplastic breast surgery](https://onco.cc/terms/oncoplastic-breast-surgery/)) - Margins and further surgery: Re-excision or mastectomy when tumour reaches the inked margin. NICE NG101 recommendation 1.4.3 offers further surgery when invasive cancer or ductal carcinoma in situ is present at the radial margin (0 mm), and recommendation 1.4.5, new in 2024, considers it when tumour cells lie within 1 mm of but not at the radial margin. The threshold for invasive cancer was lowered from 2 mm to 1 mm because the evidence could not separate 1 to 2 mm from more than 2 mm on local recurrence, and repeated operations harm appearance and self-image. For ductal carcinoma in situ alone the 2 mm threshold is retained (recommendation 1.4.4). ([Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Ductal carcinoma in situ (DCIS)](https://onco.cc/cancers/ductal-carcinoma-in-situ/), [Breast conservation or mastectomy](https://onco.cc/terms/breast-conserving-surgery-versus-mastectomy/)) - Staging the axilla when the nodes look clear: Sentinel lymph node biopsy, not axillary clearance, with dual technique using isotope and blue dye (NICE NG101 recommendations 1.4.9 and 1.4.10). NSABP B-32 randomised 5,611 women and found eight-year overall survival of 90.3 percent with sentinel node biopsy alone against 91.8 percent with added clearance (hazard ratio 1.20, 0.96 to 1.50); ALMANAC measured the gain, with lymphoedema at one year falling from 13 to 5 percent and sensory loss from 31 to 11 percent. In selected patients the sentinel node itself can now be omitted: SOUND (tumours up to 2 cm, clear axillary ultrasound) and INSEMA (T1 and T2, breast-conserving surgery) both showed non-inferiority, with axillary recurrence in INSEMA of 1.0 against 0.3 percent. Omission is only reasonable where the missing nodal information would not change the treatment plan. ([NSABP B-32](https://onco.cc/trials/nsabp-b32/), [ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance)](https://onco.cc/trials/almanac/), [SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound)](https://onco.cc/trials/sound/), [INSEMA (Intergroup Sentinel Mamma)](https://onco.cc/trials/insema/), [Sentinel node biopsy](https://onco.cc/terms/sentinel-lymph-node-biopsy/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Doing less to the armpit](https://onco.cc/terms/axillary-surgery-de-escalation/)) - A positive sentinel node: Isolated tumour cells count as node-negative and need nothing further (NICE NG101 recommendation 1.4.15). Micrometastases need nothing further either: IBCSG 23-01 found ten-year disease-free survival of 76.8 percent without clearance against 74.9 percent with it, and lymphoedema of 4 against 13 percent (recommendation 1.4.14). For one or two macrometastases, NICE recommendation 1.4.12 offers axillary clearance or axillary radiotherapy and recommendation 1.4.13 asks for a discussion of having neither after breast-conserving surgery with whole-breast radiotherapy and systemic therapy. The evidence behind that discussion is Z0011 (ten-year overall survival 86.3 against 83.6 percent) and SENOMAC (five-year recurrence-free survival 89.7 against 88.7 percent in 2,540 patients including mastectomy and T3 disease). Where the axilla is treated, AMAROS makes radiotherapy the gentler choice: ten-year axillary recurrence of 1.82 against 0.93 percent, with lymphoedema halved at 11.9 against 24.5 percent. ([ACOSOG Z0011 (Alliance)](https://onco.cc/trials/acosog-z0011/), [SENOMAC](https://onco.cc/trials/senomac/), [AMAROS (EORTC 10981-22023)](https://onco.cc/trials/amaros/), [IBCSG 23-01](https://onco.cc/trials/ibcsg-23-01/), [POSNOC](https://onco.cc/trials/posnoc/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Lymphoedema after breast cancer treatment](https://onco.cc/terms/breast-cancer-related-lymphoedema/), [Doing less to the armpit](https://onco.cc/terms/axillary-surgery-de-escalation/)) - The axilla after chemotherapy given before surgery: Sentinel node biopsy after chemotherapy is unreliable on its own: ACOSOG Z1071 found a false-negative rate of 12.6 percent against a pre-specified threshold of 10 percent. The fix is targeted axillary dissection, marking the biopsied node before chemotherapy and removing that node as well as the sentinel nodes, which brought the false-negative rate to 1.4 percent when combined with sentinel node dissection and 2.0 percent as a formal procedure. If the nodes are pathologically clear afterwards, NSABP B-51 found that regional nodal irradiation adds nothing (hazard ratio 0.88, 0.60 to 1.28, p=0.51). Whether axillary surgery can also be dropped in that situation is what ATNEC is recruiting to answer. ([ACOSOG Z1071 (Alliance)](https://onco.cc/trials/acosog-z1071/), [Targeted axillary dissection (MD Anderson prospective study)](https://onco.cc/trials/targeted-axillary-dissection-md-anderson/), [NSABP B-51 / RTOG 1304](https://onco.cc/trials/nsabp-b51/), [ATNEC](https://onco.cc/trials/atnec/), [Targeted axillary dissection](https://onco.cc/terms/targeted-axillary-dissection/), [Drugs before or after the operation](https://onco.cc/terms/neoadjuvant-versus-adjuvant-breast/)) - Radiotherapy after breast-conserving surgery: Whole-breast radiotherapy for every woman with invasive cancer and clear margins (NICE NG101 recommendation 1.13.3). The Early Breast Cancer Trialists' Collaborative Group overview of 10,801 women in 17 trials found radiotherapy cut the ten-year risk of any first recurrence from 35.0 to 19.3 percent and the fifteen-year risk of breast cancer death from 25.2 to 21.4 percent, with about one death avoided by year fifteen for every four recurrences avoided by year ten. A boost of 16 Gy to the tumour bed is offered where the risk of local recurrence is high (recommendation 1.13.17): EORTC 22881-10882 found twenty-year recurrence of 12.0 against 16.4 percent with no survival gain and severe fibrosis of 5.2 against 1.8 percent. ([NSABP B-06](https://onco.cc/trials/nsabp-b06/), [EORTC 22881-10882 (boost against no boost)](https://onco.cc/trials/eortc-22881-boost/), [Tumour bed boost](https://onco.cc/terms/tumour-bed-boost/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Leaving radiotherapy out](https://onco.cc/terms/radiotherapy-omission-early-breast-cancer/)) - Dose and schedule: In England, 26 Gy in five fractions over one week for partial-breast, whole-breast or chest-wall radiotherapy without nodal irradiation (NICE NG101 recommendation 1.13.13), and 40 Gy in fifteen fractions over three weeks when the regional nodes are treated (recommendation 1.13.16) or where a diagnosis increases radiosensitivity, an implant-based reconstruction has been done, or a three-week course is simply more acceptable (recommendation 1.13.14). The radiobiology came from three British trials: START-A held the treatment time constant and varied the fraction size, START-B established 40 Gy in fifteen, FAST estimated the alpha to beta ratio at 2.7 Gy and so predicted a five-fraction equivalent of 28 Gy, and FAST-Forward tested 26 Gy in five fractions in 4,096 women and found five-year recurrence of 1.4 against 2.1 percent. Deep inspiratory breath hold is used for left-sided cancers to lower the heart dose (recommendation 1.13.2), because major coronary events rise by 7.4 percent per gray of mean heart dose with no threshold. ([START-A (UK Standardisation of Breast Radiotherapy, trial A)](https://onco.cc/trials/start-a/), [START-B (UK Standardisation of Breast Radiotherapy)](https://onco.cc/trials/start-b/), [FAST (5-fraction whole-breast radiotherapy)](https://onco.cc/trials/fast-trial/), [FAST-Forward](https://onco.cc/trials/fast-forward/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Hypofractionation (fewer, larger radiotherapy doses)](https://onco.cc/terms/hypofractionation/), [Deep inspiration breath-hold (DIBH)](https://onco.cc/terms/deep-inspiration-breath-hold/), [Alpha/beta ratio](https://onco.cc/terms/alpha-beta-ratio/)) - Treating less than the whole breast: Partial-breast radiotherapy is considered for women who have had breast-conserving surgery for invasive cancer excluding lobular type, with clear margins, aged 50 or over with tumours of 3 cm or less, node-negative, oestrogen receptor-positive, HER2-negative, grade 1 to 2, who will take endocrine therapy for at least five years, and it must be given by external beam (NICE NG101 recommendations 1.13.4 to 1.13.6). IMPORT LOW found five-year local relapse of 0.5 against 1.1 percent with fewer changes in breast appearance, while RAPID, which gave the dose twice a day, was non-inferior on recurrence but had late toxicity of 32 against 13 percent. Intraoperative radiotherapy during the lumpectomy met its non-inferiority margin in TARGIT-A and had lower mortality from causes other than breast cancer (hazard ratio 0.59, 0.40 to 0.86), but NICE TA501 does not recommend the Intrabeam system for routine commissioning and permits it only on existing machines under NHS England governance. ([IMPORT LOW](https://onco.cc/trials/import-low/), [RAPID (accelerated partial-breast irradiation)](https://onco.cc/trials/rapid/), [NSABP B-39/RTOG 0413](https://onco.cc/trials/nsabp-b39/), [TARGIT-A (targeted intraoperative radiotherapy)](https://onco.cc/trials/targit-a/), [Partial-breast irradiation](https://onco.cc/terms/partial-breast-irradiation/), [Intraoperative radiotherapy (IORT)](https://onco.cc/technologies/intraoperative-radiotherapy/)) - Who can leave radiotherapy out: Women aged 65 and over with clear margins and a very low absolute risk of local recurrence, defined by NICE NG101 recommendation 1.13.7 as T1N0, oestrogen receptor-positive, HER2-negative, grade 1 to 2, who are willing to take endocrine therapy for at least five years. Recommendation 1.13.8 sets out what must be said: without radiotherapy local recurrence occurs in about 50 women per 1,000 at five years and with it in about 10 per 1,000; overall survival at ten years is the same; and there is no increase in serious late effects from having it in this group. CALGB 9343 (aged 70 and over, ten-year locoregional recurrence 10 against 2 percent), PRIME II (aged 65 and over, ten-year local recurrence 9.5 against 0.9 percent) and LUMINA (aged 55 and over with luminal A biology, five-year local recurrence 2.3 percent) are the trials behind it. Outside that group radiotherapy after conservation remains standard. ([CALGB 9343](https://onco.cc/trials/calgb-9343/), [PRIME II](https://onco.cc/trials/prime-ii/), [LUMINA](https://onco.cc/trials/lumina/), [Leaving radiotherapy out](https://onco.cc/terms/radiotherapy-omission-early-breast-cancer/), [Active surveillance](https://onco.cc/technologies/active-surveillance/)) - Radiotherapy after mastectomy, and to the nodes: Chest-wall radiotherapy is offered for node-positive macrometastatic disease or involved margins (NICE NG101 recommendation 1.13.10), considered for node-negative T3 or T4 disease (1.13.11) and not offered to people at low risk of local recurrence (1.13.12). SUPREMO tested it in intermediate-risk disease treated with modern systemic therapy and found ten-year overall survival of 81.4 against 81.9 percent (hazard ratio 1.04, p=0.80), with chest-wall recurrence of 1.1 against 2.5 percent. For the nodes: no regional nodal radiotherapy for histologically node-negative disease (1.13.19), no axillary radiotherapy after axillary clearance because the combination is the worst for the arm (1.13.20), supraclavicular fossa radiotherapy for four or more involved nodes (1.13.21) or for one to three with other poor prognostic factors (1.13.22), and the internal mammary chain considered within the nodal target for macrometastatic node-positive disease (1.13.23). MA.20 and EORTC 22922 are the trials behind nodal irradiation. ([SUPREMO (BIG 2-04)](https://onco.cc/trials/supremo/), [NCIC MA.20](https://onco.cc/trials/ma-20/), [EORTC 22922/10925](https://onco.cc/trials/eortc-22922/), [NSABP B-51 / RTOG 1304](https://onco.cc/trials/nsabp-b51/), [Radiotherapy after mastectomy](https://onco.cc/terms/post-mastectomy-radiotherapy/), [Mastectomy](https://onco.cc/terms/mastectomy/)) - Reconstruction: Reconstruction is offered to everyone having a mastectomy for breast cancer, and both timings, immediate and delayed, are offered whether or not they are available locally (NICE NG101 recommendations 1.5.1 and 1.5.3). Immediate reconstruction is offered even where radiotherapy is planned, unless other illness rules out the surgery (1.5.4). The choice between an implant and the woman's own tissue is a real trade: in the Mastectomy Reconstruction Outcomes Consortium, autologous reconstruction gave higher satisfaction with the breasts at two years (7.94 points, 5.68 to 10.20) but roughly double the odds of a complication, while implants failed more often (7.1 against 1.3 percent). British outcomes after implant reconstruction have been measured and are above the national standards: iBRA found implant loss of 9 percent, infection of 25 percent and return to theatre of 18 percent within three months across 81 units, and Pre-BRA found implant loss of 8.2 percent for the newer pre-pectoral technique. Mesh was used in 65 percent of iBRA reconstructions without randomised evidence; Best-BRA is the pilot trial testing implant placement properly. ([Mastectomy Reconstruction Outcomes Consortium (MROC)](https://onco.cc/trials/mroc/), [iBRA (implant Breast Reconstruction evAluation)](https://onco.cc/trials/ibra-study/), [Pre-BRA (pre-pectoral breast reconstruction evaluation)](https://onco.cc/trials/pre-bra/), [Best-BRA](https://onco.cc/trials/best-bra/), [Breast reconstruction](https://onco.cc/terms/breast-reconstruction/), [Breast implant-associated anaplastic large cell lymphoma](https://onco.cc/terms/bia-alcl/), [Mastectomy](https://onco.cc/terms/mastectomy/)) - Drugs before or after surgery: Which drugs are given is decided by receptor status and belongs on the subtype pages; when they are given is shared. The Early Breast Cancer Trialists' Collaborative Group pooled 4,756 women in ten trials of the same chemotherapy before or after surgery and found no difference in distant recurrence (38.2 against 38.0 percent at fifteen years), breast cancer mortality or death from any cause, with breast conservation achieved in 65 against 49 percent and fifteen-year local recurrence higher after chemotherapy first (21.4 against 15.9 percent, rate ratio 1.37). Treating first is chosen to make conservation possible, to make a large or node-positive tumour operable, and to see whether the drugs work, because what remains at surgery now guides what follows, differently for each receptor subtype. ([Drugs before or after the operation](https://onco.cc/terms/neoadjuvant-versus-adjuvant-breast/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/)) - Breast-conserving surgery or mastectomy: This is the decision the whole of early breast cancer turns on, and it is usually presented as a choice with the same outcome. That is true of survival and of almost nothing else, so it is worth having the actual numbers. Two randomised trials followed people for twenty years. In the Milan trial, 701 women with cancers no larger than 2 cm were assigned between 1973 and 1980 to radical (Halsted) mastectomy or to quadrantectomy followed by radiotherapy; after a median 20 years, death from any cause had occurred in 41.2 percent of the mastectomy group and 41.7 percent of the conserving group (P equals 1.0), and death from breast cancer in 24.3 and 26.1 percent (P equals 0.8). In NSABP B-06, 1,851 women were assigned to total mastectomy, lumpectomy alone, or lumpectomy with radiotherapy, and after 20 years there was no significant difference between the three in disease-free, distant-disease-free or overall survival, with a hazard ratio for death of 0.97 (0.83 to 1.14) for lumpectomy with radiotherapy against total mastectomy. Those are the cohorts they are: women treated decades ago, with the surgery and drugs of the time, and they say nothing about what will happen to one person. What they do say is that keeping the breast did not cost survival, which is why it is offered first. What differs is everything else, and this is the part usually summarised away. Radiotherapy: conserving surgery commits you to it. NICE NG101 (1.13.3) says to offer whole-breast radiotherapy after breast-conserving surgery with clear margins, and (1.13.13) 26 Gy in 5 fractions over 1 week where the lymph nodes are not being treated, or (1.13.14) 40 Gy in 15 fractions over 3 weeks where there is a reason including implant-based reconstruction, and (1.13.16) 40 Gy in 15 fractions whenever the nodes are irradiated. Mastectomy does not reliably avoid it: NG101 (1.13.10) offers radiotherapy after mastectomy for node-positive disease or involved margins, and (1.13.12) withholds it from most node-negative disease. What radiotherapy is worth after conserving surgery has been measured: in the EBCTCG meta-analysis of 10,801 women in 17 randomised trials, it cut the 10-year risk of any first recurrence from 35.0 to 19.3 percent and the 15-year risk of breast cancer death from 25.2 to 21.4 percent, with about one breast cancer death avoided by year 15 for every four recurrences avoided by year 10. For a narrow low-risk group NICE offers the choice of leaving it out: NG101 (1.13.7, 1.13.8) says to consider not using radiotherapy for women aged 65 and over with T1N0, ER-positive, HER2-negative, grade 1 to 2 cancer who will take endocrine therapy for at least 5 years, and to tell them that without radiotherapy local recurrence occurs in about 50 women per 1,000 at 5 years against about 10 per 1,000 with it, that overall survival at 10 years is the same, and that there is no increase in serious late effects from having it. A second operation: conserving surgery can need one. NG101 (1.4.3) offers further surgery where cancer is at the inked margin and (1.4.5) considers it within 1 mm, and the 2024 committee lowered that threshold from 2 mm precisely because repeated surgeries damage breast appearance and self-esteem, are traumatic, and vary in frequency across the country. How the breast looks and feels: after conserving surgery the treated breast can be smaller, firmer or dented, and NICE's own radiotherapy evidence records more clinician-assessed adverse events at 5 years and more reports of a harder or firmer breast with the one-week schedule, though it judged the differences not clinically important. After mastectomy the chest is numb over the scar whatever is done next. And what recurrence would mean: in the Milan trial, 30 of 352 women treated by quadrantectomy and radiotherapy had a recurrence in the same breast over 20 years, a crude cumulative incidence of 8.8 percent, against 8 local recurrences among 349 after radical mastectomy, 2.3 percent, with no difference in distant metastases; NSABP B-06 put in-breast recurrence at 14.3 percent over 20 years with radiotherapy and 39.2 percent without. A recurrence in a conserved breast is a further operation and a frightening year; it did not, in these trials, change survival. Finally, some cancers do not offer the choice. Macmillan lists the reasons a mastectomy is recommended: a lump large compared with the rest of the breast, cancer in different parts of the breast, widespread DCIS, cancer on the skin or in the underlying muscle, previous radiotherapy to the chest, or a gene mutation found on testing. ([Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Mastectomy](https://onco.cc/terms/mastectomy/), [Margins after breast-conserving surgery, and second operations](https://onco.cc/terms/breast-margins-and-re-excision/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [FAST-Forward](https://onco.cc/trials/fast-forward/), [START-B (UK Standardisation of Breast Radiotherapy)](https://onco.cc/trials/start-b/), [IMPORT LOW](https://onco.cc/trials/import-low/), [PRIME II](https://onco.cc/trials/prime-ii/), [LUMINA](https://onco.cc/trials/lumina/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/)) - Reconstruction surgery, delayed reconstruction, or neither: Three options, not two, and the third is a real one. NICE NG101 (1.5.1) says to offer breast reconstruction to people after they have had a mastectomy for breast cancer, and immediately afterwards (1.5.2) to be aware that some people may prefer not to have it. It also says (1.5.3) to offer both the immediate and the delayed option whether or not they are available locally, which is the sentence to quote when a local service offers only one, and (1.5.4) to offer immediate reconstruction to women advised to have a mastectomy including those who may need radiotherapy, unless comorbidities rule out reconstructive surgery. On timing, NG101's table 1 is unusually frank. Immediate reconstruction means waking with a breast shape, usually fewer operations and anaesthetics, and less scarring because the existing breast skin is used, but limited time to decide, a longer operation and recovery, and a risk that complications delay chemotherapy or radiotherapy; Cancer Research UK notes that there is good evidence chemotherapy works best started within 6 weeks of cancer surgery. Delayed reconstruction means a period with no breast, which a prosthesis can fill, but more time to choose, time to lose weight or stop smoking first, and a reconstruction that cannot be derailed by the cancer treatment. Both, NICE says, usually need more than one operation to complete, and there are no clear differences in satisfaction with completed reconstructions either way. On what each option asks of the body: an implant is the simplest operation and the shortest recovery, but NICE notes that implant-based reconstructions may be more affected by radiotherapy than flap reconstructions, and where radiotherapy is planned the route is often a tissue expander first and an exchange later, which is two operations. A flap moves skin, fat and sometimes muscle from the tummy or the back, gives a breast that ages and changes weight with you, and costs a second wound, a longer operation, a longer recovery and, where the tummy is used, a risk of hernia that smoking increases. Both carry flap or implant failure, which NICE says may lead to delayed reconstruction and a flat appearance for a period of time. Surgery to the other breast to match, called contralateral symmetrisation, is common and can be done at the same time or later. Whatever is built, Cancer Research UK says plainly that the new breast will feel and look different to the one removed: it is a shape rather than a restored breast, and it has little sensation. Choosing none is not a failure to decide. A prosthesis, specialist mastectomy wear, or nothing at all are all ordinary, and a surgeon can often make a flat chest wall even rather than leaving loose skin. For men the NHS does not routinely do implant reconstruction, because the implants available do not recreate the shape of a man's chest. After breast-conserving surgery there is a smaller version of the same conversation: where a large amount of tissue is removed the breast can be left with a dent, and a partial reconstruction using nearby tissue, or reshaping the breast (therapeutic mammoplasty, often with a reduction on the other side), can be done at the same operation. Radiotherapy still follows. ([Breast reconstruction](https://onco.cc/terms/breast-reconstruction/), [Mastectomy](https://onco.cc/terms/mastectomy/), [Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Body image after breast surgery and reconstruction](https://onco.cc/terms/body-image-after-breast-surgery/), [Numbness and nerve pain after breast surgery](https://onco.cc/terms/numbness-after-breast-surgery/), [Male breast cancer](https://onco.cc/cancers/male-breast-cancer/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/)) - Surgery to the armpit, and the lymphoedema risk that lasts for life: The armpit operation is decided almost in passing and is the single biggest determinant of how the arm feels for the rest of your life, so it is worth understanding. NICE NG101 (1.2.1) has the axilla scanned before treatment and any abnormal node sampled with a needle. If that is clear, (1.4.9) says to stage the axilla with a sentinel lymph node biopsy rather than a clearance, using (1.4.10) the dual technique of isotope and blue dye; Macmillan says this removes the smallest number of nodes possible, usually 1 to 3. If the needle biopsy already proved cancer in a node, (1.4.11) says to offer axillary node clearance. If a sentinel node turns out to contain cancer, (1.4.12) says to offer further axillary treatment, clearance or radiotherapy, for 1 or more macrometastasis; (1.4.13) says to discuss the benefits and risks of having no further treatment with women who have 1 or 2 macrometastases, have had conserving surgery, and are having whole-breast radiotherapy with systemic therapy; (1.4.14) says not to treat micrometastases further; and (1.4.15) says isolated tumour cells count as node-negative. The reason all of that exists is lymphoedema, and the figures are the part nobody hears. In a meta-analysis of 72 studies, the pooled incidence of arm lymphoedema after breast cancer was 16.6 percent, and 21.4 percent when restricted to 30 prospective cohorts, rising over the first two years; it was about four times higher after axillary lymph node dissection (19.9 percent) than after sentinel node biopsy (5.6 percent), and the risk factors with the strongest evidence were extensive surgery and being overweight or obese. That is where more than one in five comes from. Radiotherapy to the axilla instead of surgery roughly halves it: in AMAROS, 1,425 sentinel node-positive patients were randomised, and at 5 years lymphoedema affected 24.5 percent after clearance against 11.9 percent after axillary radiotherapy, while at 10 years axillary recurrence was 0.93 against 1.82 percent with no difference in survival. Two trials go further and leave the axilla alone: in ACOSOG Z0011, 891 women with 1 or 2 positive sentinel nodes having lumpectomy and whole-breast radiotherapy had 10-year overall survival of 86.3 percent without clearance against 83.6 percent with it, and in SENOMAC, 2,540 patients with 1 or 2 sentinel-node macrometastases, about 90 percent of them having nodal radiotherapy, had 5-year recurrence-free survival of 89.7 against 88.7 percent. What reduces the risk, in NICE's own 2025 words: information before treatment starts in a format to take away, covering risk reduction, early signs, skin changes, how to self-monitor and how to take baseline measurements of the limb (1.14.1); keeping to a healthy weight and keeping the arm moving, because (1.14.3) physical activity does not cause or worsen lymphoedema and may improve quality of life; and skin care, because infection is what tips a vulnerable arm over. NICE also clears away some folklore: (1.14.1) says there is no consistent evidence of increased risk from air travel, travel to hot countries, manicures, hot tub use or sports injuries, nor from blood tests, injections, intravenous medicines or blood pressure measurement on the treated side, and (1.14.2) makes procedures on that arm a shared decision rather than a prohibition. It says (1.14.4) not to offer compression garments as prevention to people who are only at risk. Recognising it early is the whole game. Breast Cancer Now describes swelling that comes and goes and is worse at the end of the day, rings and watches suddenly tight, tightness in the arm or breast without visible swelling, a dull ache, heaviness, tingling or numbness, dry skin, and later hardness or pins and needles. NICE (1.14.6) says to refer anyone who develops it to a specialist lymphoedema service as soon as possible. Treatment exists and works: (1.14.8) assess for other causes such as nodal disease or cellulitis first, (1.14.9) compression therapy as the first stage with a shared decision about the form, (1.14.10) kinesiology tape if compression is not tolerated, and (1.14.11) reassurance that exercise is safe. The NHS calls the whole package decongestive lymphatic therapy: compression, skin care, exercise and specialised massage, then a maintenance phase you run yourself. It is controlled rather than cured, which is why it is worth catching in the first weeks. Alongside lymphoedema sits the shoulder. NG101 (1.14.14) says to identify people as high risk before surgery if they have a pre-existing shoulder problem, a BMI over 30, planned axillary node clearance, or planned radiotherapy to the axilla or supraclavicular nodes, (1.14.16) to offer them supervised support with upper limb exercises, and (1.14.19) to refer anyone with a persistent reduction in arm and shoulder mobility to physiotherapy. ([Sentinel node biopsy](https://onco.cc/terms/sentinel-lymph-node-biopsy/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Lymphoedema after breast cancer treatment](https://onco.cc/terms/lymphoedema-after-breast-cancer/), [Cording (axillary web syndrome)](https://onco.cc/terms/cording-axillary-web-syndrome/), [Seroma after breast surgery](https://onco.cc/terms/seroma-after-breast-surgery/), [Compression, decongestive therapy and exercise for lymphoedema](https://onco.cc/technologies/lymphoedema-decongestive-therapy/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/)) - Fertility and early menopause, decided before treatment starts: This is the decision with a deadline. Chemotherapy can stop the ovaries working, temporarily or permanently, and treatment can bring the menopause forward by decades; once treatment has started, some of the options have gone. NICE NG101 (1.1.5) hands fertility preservation to the NICE fertility guideline, now NG257 (2026), and NG257 (1.53.1) says to discuss it with people preparing for treatment likely to impair their fertility, and that where treatment is urgent the discussion should happen at the earliest possible opportunity. The route it names is (1.53.6) oocyte or embryo cryopreservation for people of reproductive age with female reproductive organs, (1.53.5) sperm cryopreservation for those with male reproductive organs, which matters because men get breast cancer too, and (1.53.7) ovarian tissue cryopreservation where the others are not feasible. Two sentences in NG257 are worth carrying into the room. The first is (1.53.3): for NHS-funded fertility preservation, do not apply the eligibility criteria used for conventional fertility treatment, including the lower age limit. The rules about age, existing children and BMI that govern NHS IVF are not supposed to be applied to preserving fertility before cancer treatment. The second is (1.53.4): those criteria will apply later, when you come to use the stored material, so the funding question has two halves and it is worth asking both. Storage is reviewed at least every 5 years and NHS funding continues for people who remain at significant risk (1.53.8). On timing, Cancer Research UK says collecting and freezing eggs takes about 2 to 3 weeks, that IVF is the most effective method, that letrozole or tamoxifen can be used with lower-dose stimulation, and that IVF is available for some people on the NHS but not everywhere, so the answer varies by where you live. Where there is no time for any of that, the other route is switching the ovaries off during chemotherapy with a GnRH agonist injection. In an individual patient-level meta-analysis of 873 patients from five randomised trials, premature ovarian insufficiency occurred in 14.1 percent of those given a GnRH agonist against 30.9 percent of controls (adjusted odds ratio 0.38), and at least one pregnancy after treatment in 10.3 against 5.5 percent, with no significant difference in disease-free or overall survival. The trial that opened this question, POEMS, randomised 257 premenopausal women with operable hormone receptor-negative breast cancer and found ovarian failure at 2 years in 8 percent on goserelin against 22 percent, with pregnancy in 21 against 11 percent. Whether this is offered as well as, or instead of, egg freezing is a conversation for the fertility clinic rather than a substitute for it. If the menopause arrives anyway, it arrives fast and without the years of warning a natural menopause gives. NICE NG101 (1.14.20) says to offer women information and counselling about the possibility of early menopause and its symptoms, and (1.14.21) to stop systemic HRT at diagnosis. On treating the symptoms it is restrictive and says so: (1.14.22) do not routinely offer HRT to women with a history of breast cancer; (1.14.23) offer it in exceptional circumstances for severe symptoms after discussing the risks; (1.14.24) consider an SSRI for hot flushes, but not for women taking tamoxifen; and (1.14.25) do not offer soy, red clover, black cohosh, vitamin E or magnetic devices. Bone follows: (1.14.26) offer a baseline DEXA scan to women not on adjuvant bisphosphonates who are starting an aromatase inhibitor, have a treatment-induced menopause, or are starting ovarian suppression; (1.14.27) not to those on tamoxifen alone; and (1.14.28) bisphosphonates for those the UK expert group algorithms identify. Whether it is safe to pause endocrine therapy to try for a baby is a question for hormone receptor-positive disease and is answered on that page. ([Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/), [Menopause symptoms after chemotherapy for breast cancer](https://onco.cc/terms/menopause-after-chemotherapy-breast/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Male breast cancer](https://onco.cc/cancers/male-breast-cancer/), [Cognitive behavioural therapy for fatigue and distress](https://onco.cc/technologies/cbt-fatigue-distress/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/)) - Body image, sensation and sex: Start with the thing almost nobody is told before they consent. Breast and armpit surgery cuts small sensory nerves, so an area of the chest, the breast, the armpit and the upper inner arm is numb afterwards. Cancer Research UK puts it as numbness, tingling or a shooting pain in the armpit, upper arm, shoulder or chest wall from nerve damage during surgery, and says the nerves usually repair themselves but it can take many weeks or months. The longer-term picture comes from a Danish national survey: of 3,253 women aged 18 to 70 who answered a median of 26 months after surgery, 1,543 (47 percent) reported pain in the treated area, 201 of them severe and 595 moderate; the odds of persistent sensory disturbance were about five times higher after axillary lymph node dissection than after sentinel lymph node dissection (odds ratio 4.97, 3.92 to 6.30) and five times higher in women aged 18 to 39; radiotherapy raised the odds of pain and chemotherapy did not. Only about 1 in 5 of those in pain had spoken to a doctor about it in the previous three months, which is the second half of the problem: it is treatable, and people do not report it because they were never told to expect it. A reconstructed breast has little or no sensation however good it looks, and a spared nipple usually has none. Cancer Research UK says the new breast will feel and look different to the one removed. That is worth asking about separately from appearance, before the operation, because it is not something a photograph shows. On the body you are left with: Cancer Research UK says swelling and bruising go down and scars fade, but it may take up to a year for things to settle, and that the first few months can bring intense feelings. NICE NG101 (1.1.2) says to offer all people with breast cancer prompt access to specialist psychological support and, where appropriate, psychiatric services, which makes asking for it a request for something already promised. Breast Cancer Now's Someone Like Me pairs people with a volunteer who has been through something similar, and Maggie's centres are free and need no appointment. On sex, plainly. Cancer Research UK says breast surgery does not affect your ability to have sex, but that emotions may change sexual feelings for a while and that you might worry about letting a partner see or touch your body. The physical obstacles are usually treatable and usually unmentioned: numbness where the breast used to respond, a chest wall that hurts to lie on, shoulder stiffness that makes positions awkward, fatigue, and, where treatment has forced the menopause, vaginal dryness and pain, which is a symptom with treatments rather than something to endure. NICE NG101 (1.14.20) puts information and counselling about menopausal symptoms into the guideline. Nothing here assumes the reader is a woman, has a partner, is heterosexual, or has stopped wanting sex. Men with breast cancer have their own page and the same conversation is owed to them; the NHS does not routinely offer implant reconstruction to men because the implants available do not recreate the shape of a man's chest, which makes the scar and the sensation the whole of the outcome. ([Numbness and nerve pain after breast surgery](https://onco.cc/terms/numbness-after-breast-surgery/), [Body image after breast surgery and reconstruction](https://onco.cc/terms/body-image-after-breast-surgery/), [Breast reconstruction](https://onco.cc/terms/breast-reconstruction/), [Menopause symptoms after chemotherapy for breast cancer](https://onco.cc/terms/menopause-after-chemotherapy-breast/), [Male breast cancer](https://onco.cc/cancers/male-breast-cancer/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/), [Quality of life](https://onco.cc/terms/quality-of-life/)) - Hair, and whether scalp cooling is worth it: It is the first question people ask and the one answered with the least detail, so here is what is known. Not every breast cancer treatment causes hair loss: it depends on the drugs, which depend on the receptor result, and the subtype pages list the regimens. Where it happens, Macmillan says it usually starts after the first or second treatment, that eyebrows and eyelashes can go as well, and that hair usually starts to grow back after treatment, sometimes with a different texture or colour. Scalp cooling is the only thing that changes the outcome. In the SCALP randomised trial, 50.5 percent of women cooled during taxane, anthracycline or both kept more than half their hair after the fourth cycle, against none of the controls. That is the honest headline: about half kept enough hair to go without a wig, and about half did not, and the trial counted keeping more than half rather than keeping all of it. The figure is better with taxane-only regimens and worse with anthracyclines. A caveat that belongs beside every one of those numbers: the trials that produced them had few Black participants, and a later phase II study of the Paxman device in Black patients having chemotherapy for stage I to III breast cancer closed early after 15 of a planned 30 participants for lack of efficacy, with hair loss and distress scores rising during cooling and only one participant avoiding significant loss; the authors named hair thickness, hair volume and cap design as the likely reasons. Anyone quoting one in two should say whose hair it was measured on. Practically, cooling means wearing a tight cold cap from before the infusion until some time after it, so treatment days get longer, and it is uncomfortable at the start. Availability varies by unit, so whether it is offered at all is a question for the first chemotherapy appointment rather than the third. If you would want a wig, Macmillan says to get it before treatment starts, because matching your own colour and style is easier while you still have it and you can get used to wearing it; buying and practising with eyebrow and eyelash products beforehand works the same way. Some people shave their heads first for the sense of control. The Little Princess Trust provides free real-hair wigs to people up to the age of 24. None of this is vanity. Hair is how most people are recognised, including by themselves, and losing it is often the moment a diagnosis becomes visible to everyone else. ([Hair loss and scalp cooling with breast cancer chemotherapy](https://onco.cc/terms/hair-loss-and-scalp-cooling-breast/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/)) - Survivorship: follow-up, and which symptom is worth a phone call: Follow-up after breast cancer is lighter than most people expect, and the reason is that scans of people without symptoms have never been shown to help. NICE NG101 (1.15.1) says to offer annual mammography for 5 years to everyone who has had or is being treated for breast cancer including DCIS, and for women to continue annual mammography past 5 years until they enter the NHS Breast Screening Programme in England or the Breast Test Wales Screening Programme; (1.15.2) not to do mammography of the ipsilateral soft tissues after a mastectomy; and (1.15.3) not to use routine ultrasound or MRI for post-treatment surveillance. That first rule is under revision: NICE reviewed the guideline on 11 September 2026 and says it will be updating the recommendation on annual mammography, following a surveillance decision taken in June 2026, with no new wording published yet. What replaces the scans is a document and a phone number. NG101 (1.15.4) says to ensure everyone who has had treatment has an agreed written care plan, recorded in the notes by a named professional and copied to them and their GP, that names the designated healthcare professionals, the dates for reviewing any adjuvant therapy, the details of surveillance mammography, the signs and symptoms to look out for and seek advice on, the contact details for immediate referral to specialist care, and the contact details for support services such as lymphoedema. If you do not have that piece of paper, asking for it is asking for something the guideline already promised. Which symptoms count. Breast Cancer Now gives a three-part rule that is easier to hold than a list: talk to your GP or breast care nurse about any symptom that is new, has no obvious cause, and does not go away, and it says the same rule applies to people already living with secondary breast cancer, where a new symptom may mean the cancer is progressing. Its organ-by-organ list is the one to keep: in the bone, pain that does not improve with painkillers and may be worse lying down or at night, a fracture, or unexplained back pain with difficulty walking, numbness or loss of bladder or bowel control; in the lungs, breathlessness on activity or at rest, a cough that does not go away, or chest pain or tightness that persists; in the liver, pain under the right ribs or in the right shoulder, sickness, loss of appetite and weight, hiccups, a swollen abdomen or yellowing of the skin; in the brain, headache, morning sickness or vomiting, weakness or numbness down one side, unsteadiness, seizures, speech or vision problems, or changes in behaviour or memory; in the skin or the chest wall, a rash, a change in skin colour, or a firm painless lump; and in the lymph nodes, a lump or swelling under the arm, breastbone or collarbone. Three general ones sit above the list: constant tiredness, constant nausea, and unexplained weight loss and loss of appetite. The point of writing them down is not to make the reader watch for cancer in every ache. It is that the three-part test, new plus unexplained plus persistent, is what distinguishes the ache that needs a call from the one that does not, and having it in advance is what stops people waiting months out of a wish not to make a fuss. Alongside all of this, NG101 (1.4.16, 1.4.17) asks every breast unit to audit its local, regional, distant and axillary recurrence rates, including radial margins and demographic information such as socioeconomic status, age and ethnicity, which is a fair thing to ask your own unit about. ([Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Brain metastases (intracranial disease)](https://onco.cc/terms/brain-metastases/), [Metastatic spinal cord compression (MSCC)](https://onco.cc/terms/metastatic-spinal-cord-compression/), [Lymphoedema after breast cancer treatment](https://onco.cc/terms/lymphoedema-after-breast-cancer/), [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Financial toxicity and financial navigation](https://onco.cc/technologies/financial-navigation/), [Work and money during breast cancer treatment (UK)](https://onco.cc/terms/work-and-money-breast-cancer-uk/), [Carers: what you can do and UK carer support (breast cancer)](https://onco.cc/terms/carers-breast-cancer-uk/)) ## State of the art - Five-year survival above 90 percent in early disease across high-income countries, driven by screening, endocrine therapy and HER2-targeted drugs. - Antibody-drug conjugates such as trastuzumab deruxtecan have redrawn the HER2 boundary and moved into HER2-low disease. - Genomic tests spare most node-negative hormone receptor-positive patients chemotherapy. - Omission of radiotherapy in older low-risk women and one-week hypofractionation are reducing treatment burden. - The operation has shrunk twice over. Breast conservation replaced mastectomy for most early cancers on four trials that all reported at twenty years or more with no survival difference, and the axilla has gone from full clearance to one or two sentinel nodes to, in SOUND and INSEMA, no axillary operation at all for small tumours with a clear ultrasound. - Radiotherapy has gone from five weeks to one. England now gives 26 Gy in five fractions over a week as the default whole-breast, partial-breast or chest-wall schedule when the nodes are not treated, on a chain of British trials running from START-A through START-B and FAST to FAST-Forward. - De-escalation is now guided by response as well as by risk. NSABP B-51 showed that regional nodal irradiation can be dropped when chemotherapy given first clears the nodes, and SUPREMO found no survival gain from chest-wall radiotherapy in intermediate-risk disease treated with modern drugs. ## Open problems - The receptor result produces four boxes and the world is organised around three. One report gives a hormone receptor answer and a HER2 answer, and the four combinations are unequal: 70.1 percent hormone receptor-positive HER2-negative, 9.3 percent positive for both, 4.0 percent HER2-positive alone and 10.8 percent triple-negative (SEER 21, 2019 to 2023). Guidelines, trials and patient information are written for three subtypes, so the largest HER2-positive group, the people who are hormone receptor-positive as well, have to read two sets of advice and work out where they overlap. - The classification a report is written against is two years behind the classification in print. The sixth edition of the WHO classification of breast tumours appeared in April 2026 and changed the vocabulary of subtype, pattern and variant, the HER2 reporting categories and the criteria for several types; the UK reporting dataset in force was written against the fifth edition and is due for review in November 2026. Every page in this family, and every report a patient is holding, is currently a fifth-edition document, and there is no mechanism that tells a patient which edition her report was written to. - Stage does not contain grade or the receptors, and the tools that patch the gap disagree with each other. The UK dataset says so in its own words, which is why the Nottingham Prognostic Index and PREDICT exist; America solved the same problem inside the stage number with the AJCC prognostic stage, which the UK dataset advises against using. A British and an American clinician can therefore give the same tumour a different stage, and PREDICT is explicitly less accurate in women under 30, women over 70, tumours over 50 mm, and has never been validated in men. - Receptor conversion is measured but not acted on by evidence. On meta-analysis of 39 paired studies, 22.5 percent of oestrogen receptor-positive primaries had become negative in their metastases and 21.3 percent of HER2-positive ones had, with conversion in the other direction too; NICE asks only that reassessment be considered where it would change management. No prospective study has shown what treating on the metastasis rather than the primary does to survival, so the commonest decision in relapsed breast cancer rests on a biological argument rather than a trial (Schrijver 2018). - The measurements underneath every one of these systems are less precise than the decisions they drive. Grade agrees between core biopsy and surgical specimen about 70 percent of the time; the national screening programme's quality assurance scheme finds poor agreement between pathologists on tumour size even on prepared slides; there is no internationally agreed method for scoring oestrogen receptor; and pathologists disagree at the HER2 0 to 1+ boundary that now decides eligibility for an antibody-drug conjugate. - POSNOC is the only trial in which a woman with a positive sentinel node receives no axillary treatment at all, radiotherapy included; until it reports, every de-escalation result rests on an axilla that was quietly irradiated in nine cases out of ten. - Every partial-breast irradiation trial required pathological nodal staging for eligibility, so the women who now have no sentinel node biopsy under SOUND and INSEMA criteria fall outside the evidence for the radiotherapy they are being offered. - Implant-based reconstruction in the United Kingdom runs above the National Quality Standards on implant loss, infection, reoperation and readmission, and mesh was in majority use for years without a randomised trial; Best-BRA is a pilot, not an answer. - The de-escalation portfolio is inefficient. A systematic review of 97 trials in up to 94,866 participants found multiple studies asking nearly the same question, with patients rarely involved in designing them. - Radiotherapy omission is defined by age thresholds that biology does not respect. LUMINA selected by luminal A biology rather than by age and got a lower recurrence rate than the age-based trials, but the guidelines still key the decision to 65 or 70. ## Notes - Which page is mine? Start with the receptor result, because that is the only one of the three things on your report that chooses a page. If you were told the cancer is oestrogen receptor positive (or progesterone receptor positive) and HER2 negative, your page is HR-positive / HER2-negative breast cancer, and you are in the largest group, 70.1 percent of American cases with a known subtype (SEER 21, 2019 to 2023). If you were told HER2 positive, your page is HER2-positive breast cancer whatever the oestrogen receptor says, because HER2 chooses the treatment backbone; and if you were told you are hormone receptor positive as well, which is true of about seven in ten HER2-positive cancers (9.3 percent of all cases against 4.0 percent hormone receptor negative), you will also have endocrine treatment, and the HR-positive page is where that is explained. If you were told all three are negative, your page is triple-negative breast cancer, 10.8 percent of American cases and around 15 percent on Cancer Research UK's page. If you were told an oestrogen receptor figure between 1 and 10 percent, or the phrase ER low positive, read both the HR-positive and the triple-negative pages and the term on the threshold, because that band behaves more like triple-negative disease and the endocrine benefit is uncertain. - Which page is mine, continued: the answers that are not a receptor result. If you have been told a type rather than a receptor status, the type has a page: invasive carcinoma of no special type, which is the ordinary kind and is what most of this family is written about; invasive lobular carcinoma, about 15 percent of cases; or one of the special types, tubular, mucinous, cribriform, papillary, micropapillary, metaplastic, apocrine, secretory, adenoid cystic, neuroendocrine, or carcinoma with a medullary pattern. If you were told in situ, non-invasive or stage 0, you have ductal carcinoma in situ or lobular carcinoma in situ, which are staged Tis and are not invasive cancer; lobular carcinoma in situ is closer to a risk marker than a cancer. If the breast became red, swollen and hot over weeks, that is inflammatory breast cancer, staged T4d and diagnosed clinically. If the change is an eczema-like nipple, that is Paget disease of the nipple. If the lump turned out to be a fibroepithelial tumour, that is a phyllodes tumour, not a carcinoma, and it is not treated with any of the drugs on the receptor pages. If you are a man, there is a page for male breast cancer. And if you are here because of a screening recall rather than a diagnosis, a recall is not a diagnosis: most people recalled after a mammogram do not have cancer, and the NHS pathway page explains what happens next. - Which page is mine, continued: grade, stage and the words that are not pages. A grade is not a page. Someone told 'grade 3, triple negative' should go to the triple-negative page: grade 3 is the commonest grade in triple-negative disease and it changes the prognosis, not the route. A stage is not a page either, although each receptor page splits into early and advanced disease at the second click, and there are pages for high-risk early hormone receptor-positive disease, for hormone receptor-positive disease after CDK4/6 inhibitors, for early HER2-positive disease, for HER2-positive brain metastases and for early and metastatic triple-negative disease. Luminal A and luminal B, basal-like and claudin-low are names from gene expression profiling rather than from a report, and they live in the glossary. HER2-low and HER2-ultralow are not a fourth receptor status: they describe a HER2-negative cancer with a little HER2 on it, and they change what is available only once the disease is advanced. - What breast cancer is. The breast is a branching tree of fifteen to twenty duct systems, each ending in lobules, the clusters of sacs that make milk. Almost all breast cancer begins where the smallest duct meets its lobule, the terminal duct lobular unit, and the names of the two commonest kinds are therefore misleading in a useful way: neither invasive carcinoma of no special type, still widely called invasive ductal carcinoma, nor invasive lobular carcinoma starts where its name suggests. What really separates them is E-cadherin, the protein that glues cells to their neighbours: lobular cancers have lost it, so they spread in single files instead of forming a lump, which makes them harder to feel, harder to see on a mammogram and harder to measure. While the cancer is still inside the duct or lobule it cannot spread and is called carcinoma in situ; once it has crossed the basement membrane it is invasive, and can reach the lymph nodes in the armpit and, from there or through the blood, the bones, liver, lungs and brain. - Why the receptors decide everything. Breast cancer was the first cancer shown to be driven by a hormone that could be taken away: Beatson removed the ovaries of women with advanced breast cancer in 1896, and it worked in some of them. Most breast cancers are fed by oestrogen through the oestrogen receptor in the nucleus, and blocking that receptor or removing the hormone works; a minority instead make far too much of a growth-signal protein called HER2 on their surface, and antibodies and antibody-drug conjugates aimed at HER2 work; and a minority have neither, so neither treatment applies and chemotherapy, immunotherapy and, for people with an inherited BRCA fault, PARP inhibitors are used. That is why the first question after diagnosis is not how big or how far, but which of these the cancer is, and why NICE asks for all three receptor results to be requested at once on the first biopsy rather than one after another (NG101 1.3.1). - Is grade the same as stage? No, and confusing them is the commonest misunderstanding on a breast report. Grade is how abnormal the cells look under the microscope, from 1 to 3, and it is a property of the cancer's behaviour. Stage is how much cancer there is and how far it has gone, from 0 to IV, and it is a property of the situation. A small grade 3 cancer and a large grade 1 cancer are different problems, and the report gives you both because neither can be worked out from the other. The UK dataset makes the same point about its own staging system: the UICC classification, it says, does not incorporate histological grade or receptor status, which is why the Nottingham Prognostic Index and PREDICT exist to put them back together. - Why the numbers on my report are given to the nearest whole grade and my friend's cancer had an Oncotype score. Grade, size and node status are measured in the hospital laboratory and are on every report. A genomic recurrence score, such as Oncotype DX, MammaPrint, Prosigna or EndoPredict, is an extra test sent away in some hormone receptor-positive, HER2-negative, node-negative cancers to decide whether chemotherapy is worth adding, and it is not done in all cases and not in other subtypes. It is not a better version of the grade; it answers a narrower question, and NICE has separate diagnostics guidance on which of these tests may be used. - How the outlook is described, and how it is not. Population figures for breast cancer are averages over everyone diagnosed in a period, and for this cancer they are unusually favourable: 76.6 percent of UK women survive ten years or more, and five-year relative survival in the United States is 91.9 percent across all breast cancer. They are also unusually stratified: 95.8 percent five-year survival in hormone receptor-positive HER2-negative disease against 78.7 percent in triple-negative disease, and within triple-negative disease 92.8 percent when it is localised against 14.9 percent when it is distant (SEER 21, 2016 to 2022). No one of those numbers is a prediction about a person, and the number that moves them most is not the subtype but the stage at which the cancer was found. - Living with breast cancer, the decisions that are shared: This is orientation from public patient pages, guidelines and the trials themselves, not advice for your case: your own team's instructions and 24-hour number come first, and no figure on this page is a prediction about you. The seven decision rows above, the question sets for the surgeon, breast care nurse, oncology, radiotherapy planning, fertility and lymphoedema appointments and for partners and carers, the first 60 days checklist and the red cards were written from NICE NG101, NG257, NG234 and CG151 and from the NHS, Macmillan, Cancer Research UK, Breast Cancer Now and Maggie's, with every trial figure taken from the trial's own publication rather than from a summary of it. - On what is here and what is not. Breast cancer is three diseases wearing one name, and the pages for hormone receptor-positive, HER2-positive and triple-negative disease carry the drug decisions that follow the receptor result. This page carries only what is true whichever result comes back: the operation, the armpit, the arm, fertility and the menopause, the body you are left with, hair, and follow-up. Where a subtype page says it better, this page points there rather than saying it again. - On the survival figures. They come from two randomised trials that followed people for twenty years, the Milan trial of 701 women with cancers under 2 cm and NSABP B-06 with 1,851 women, both started in the 1970s, and from the EBCTCG meta-analysis of 10,801 women in 17 radiotherapy trials. They describe those cohorts, treated with the surgery and drugs of their time. They are quoted because the alternative, the phrase similar outcomes, tells a reader nothing about what is actually being traded. No sentence on this page is a forecast for one person. - On the word women. NICE writes several of these recommendations about women specifically, including the reconstruction and menopause sections, and the wording is kept as NICE wrote it rather than quietly broadened. Everywhere else this page says people, because about 420 of the roughly 59,000 breast cancers diagnosed in the UK each year are in men, and the male breast cancer page exists for them. The lymphoedema section of NG101 says the same thing in its own rationale: the committee recognised that while breast cancer predominantly affects women, men can also be affected, and extrapolated the evidence to make recommendations that address the needs of all breast cancer patients. - On lymphoedema, which is the reason this layer exists in the form it does. It is lifelong, it affects more than one in five people after axillary clearance, it is badly covered on almost every page a newly diagnosed person will read, and nearly everything that reduces it is decided in the first month: which armpit operation, whether radiotherapy replaces clearance, whether anyone measured the arm before surgery, and whether anyone explained the early signs. NICE rewrote its recommendations on it in 2025 and they are quoted at length above for that reason. ## Sources - Wikipedia: https://en.wikipedia.org/wiki/Breast_cancer - Wikipedia: https://en.wikipedia.org/wiki/Breast_cancer - NCI PDQ: https://www.cancer.gov/types/breast - NICE NG101: early and locally advanced breast cancer, diagnosis and management (published 18 July 2018, last updated 14 April 2025): https://www.nice.org.uk/guidance/ng101/chapter/recommendations - Royal College of Pathologists G148: dataset for histopathological reporting of breast disease in surgical excision specimens of breast cancer, version 3, November 2024 (full review due November 2026): https://www.rcpath.org/resourceLibrary/g148-dataset-for-histopathological-reporting-of-breast-disease-in-surgical-excision-specimens-of-breast-cancer.html - NICE CG81: advanced breast cancer, diagnosis and treatment, diagnosis and assessment section (published 23 February 2009, last updated 30 June 2026): https://www.nice.org.uk/guidance/cg81/chapter/Diagnosis-and-assessment - Brierley et al., International Journal of Cancer 2026: the 9th edition of the UICC TNM classification of malignant tumours, updates and rationale for change (breast: the classification remains unchanged, the yp classification is clarified): https://doi.org/10.1002/ijc.70561 - UICC: TNM Classification of Malignant Tumours, 9th edition, recommended to take effect from 1 January 2026: https://www.uicc.org/what-we-do/sharing-knowledge/tnm - Quinn et al., Histopathology 2026;89(2):199 to 218: World Health Organization classification of tumours of the breast, 6th edition 2026: https://doi.org/10.1111/his.70149 - Tan et al., Histopathology 2020: the 2019 WHO classification of tumours of the breast (5th edition): https://doi.org/10.1111/his.14091 - Elston and Ellis, Histopathology 1991;19:403 to 410: pathological prognostic factors in breast cancer, the value of histological grade, with long-term follow-up of 1,831 graded patients: https://doi.org/10.1111/j.1365-2559.1991.tb00229.x - Galea, Blamey, Elston and Ellis, Breast Cancer Research and Treatment 1992;22:207 to 219: the Nottingham Prognostic Index in primary breast cancer: https://doi.org/10.1007/bf01840834 - Allison et al., Journal of Clinical Oncology 2020;38:1346 to 1366: oestrogen and progesterone receptor testing in breast cancer, ASCO/CAP guideline update: https://doi.org/10.1200/jco.19.02309 - Rakha et al., Journal of Clinical Pathology 2023;76:217 to 227: UK recommendations for HER2 assessment in breast cancer, an update: https://doi.org/10.1136/jcp-2022-208632 - Schrijver et al., Journal of the National Cancer Institute 2018: receptor conversion in distant breast cancer metastases, a systematic review and meta-analysis of 39 studies: https://doi.org/10.1093/jnci/djx273 - SEER Cancer Stat Facts: female breast cancer subtypes (share of cases and five-year relative survival by receptor subtype and stage, SEER 21): https://seer.cancer.gov/statfacts/html/breast-subtypes.html - SEER Cancer Stat Facts: female breast cancer (incidence, stage distribution and survival): https://seer.cancer.gov/statfacts/html/breast.html - GLOBOCAN breast fact sheet (IARC Global Cancer Observatory, 2024 estimates): https://gco.iarc.who.int/media/globocan/factsheets/cancers/20-breast-fact-sheet.pdf - Cancer Research UK: breast cancer statistics (UK incidence, mortality, survival, stage at diagnosis and routes to diagnosis): https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer - Cancer Research UK: types of breast cancer: https://www.cancerresearchuk.org/about-cancer/breast-cancer/types - NHS: breast cancer in women, symptoms: https://www.nhs.uk/conditions/breast-cancer/symptoms/ - NHS: breast cancer in women: https://www.nhs.uk/conditions/breast-cancer-in-women/ - NHS: tests and next steps for breast cancer in women: https://www.nhs.uk/conditions/breast-cancer-in-women/tests-and-next-steps-for-breast-cancer-in-women/ - NHS: treatment for breast cancer in women: https://www.nhs.uk/conditions/breast-cancer-in-women/treatment-for-breast-cancer-in-women/ - NHS: help and support for breast cancer in women: https://www.nhs.uk/conditions/breast-cancer-in-women/help-and-support-for-breast-cancer-in-women/ - NHS: breast cancer in men: https://www.nhs.uk/conditions/breast-cancer-in-men/ - NHS: mastectomy: https://www.nhs.uk/tests-and-treatments/mastectomy/ - NHS: lymphoedema: https://www.nhs.uk/conditions/lymphoedema/ - NHS: lymphoedema, treatment: https://www.nhs.uk/conditions/lymphoedema/treatment/ - NHS: cellulitis: https://www.nhs.uk/conditions/cellulitis/ - NHS: menopause and perimenopause, symptoms: https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/ - NHS: sepsis: https://www.nhs.uk/conditions/sepsis/ - NHS: clinical trials: https://www.nhs.uk/tests-and-treatments/clinical-trials/ - NHS: when to use 111: https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-use-111/ - NHS: when to call 999: https://www.nhs.uk/nhs-services/urgent-and-emergency-care-services/when-to-call-999/ - NHS: carer's assessments: https://www.nhs.uk/social-care-and-support/support-and-benefits-for-carers/carer-assessments/ - NHS: benefits for carers: https://www.nhs.uk/social-care-and-support/support-and-benefits-for-carers/benefits-for-carers/ - NICE NG101: early and locally advanced breast cancer, recommendations (updated 2025): https://www.nice.org.uk/guidance/ng101/chapter/Recommendations - NICE NG257: fertility problems, fertility preservation for medical indications (2026): https://www.nice.org.uk/guidance/ng257/chapter/Fertility-preservation-for-medical-indications - NICE NG234: spinal metastases and metastatic spinal cord compression, recommendations: https://www.nice.org.uk/guidance/ng234/chapter/Recommendations - NICE CG151: neutropenic sepsis: https://www.nice.org.uk/guidance/cg151 - Macmillan: breast-conserving surgery: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/breast-conserving-surgery-for-breast-cancer - Macmillan: removing the breast (mastectomy): https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/removing-the-breast-mastectomy - Macmillan: breast reconstruction: https://www.macmillan.org.uk/cancer-information-and-support/breast-cancer/breast-reconstruction - Macmillan: surgery to the lymph nodes for breast cancer: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/surgery-to-the-lymph-nodes-for-breast-cancer - Macmillan: radiotherapy for breast cancer: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/radiotherapy-for-breast-cancer - Macmillan: lymphoedema: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/lymphoedema - Macmillan: hair loss: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/hair-loss - Macmillan: fertility: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/fertility - Macmillan: sepsis: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/sepsis - Macmillan: work and cancer: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/work-and-cancer - Macmillan: looking after someone with cancer: https://www.macmillan.org.uk/cancer-information-and-support/supporting-someone/looking-after-someone-with-cancer - Macmillan: questions to ask your healthcare team: https://www.macmillan.org.uk/cancer-information-and-support/treatment/your-treatment-options/questions-to-ask-your-healthcare-team - Cancer Research UK: breast reconstruction: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/breast-reconstruction - Cancer Research UK: life after breast cancer surgery: https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/life-after-surgery - Cancer Research UK: possible problems after mastectomy: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/after-surgery/problems-after-mastectomy - Cancer Research UK: preserving fertility with breast cancer: https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/preserving-fertility - Cancer Research UK: menopausal symptoms and breast cancer: https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/menopausal-symptoms - Cancer Research UK: lymphoedema after breast cancer treatment: https://www.cancerresearchuk.org/about-cancer/breast-cancer/living-with/lymphoedema-after-treatment - Cancer Research UK: having radiotherapy for breast cancer: https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/radiotherapy/radiotherapy-treatment - Cancer Research UK: prehabilitation: https://www.cancerresearchuk.org/about-cancer/treatment/prehabilitation - Breast Cancer Now: lymphoedema: https://breastcancernow.org/about-breast-cancer/treatment/lymphoedema - Breast Cancer Now: surgery for primary breast cancer: https://breastcancernow.org/about-breast-cancer/treatment/surgery-for-primary-breast-cancer - Breast Cancer Now: secondary breast cancer symptoms: https://breastcancernow.org/about-breast-cancer/secondary-breast-cancer/secondary-breast-cancer-symptoms - Breast Cancer Now: coping with breast cancer emotionally: https://breastcancernow.org/about-breast-cancer/life-after-treatment/coping-with-breast-cancer-emotionally - Maggie's: support and information: https://www.maggies.org/support-and-information/ - Cancer Research UK: breast cancer incidence statistics (invasive): https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive - Veronesi et al., twenty-year follow-up of breast-conserving surgery versus radical mastectomy, Milan trial (NEJM 2002): https://doi.org/10.1056/NEJMoa020989 - Fisher et al., twenty-year follow-up of total mastectomy, lumpectomy, and lumpectomy plus irradiation, NSABP B-06 (NEJM 2002): https://doi.org/10.1056/NEJMoa022152 - EBCTCG, radiotherapy after breast-conserving surgery: meta-analysis of 10,801 women in 17 randomised trials (Lancet 2011): https://doi.org/10.1016/S0140-6736(11)61629-2 - DiSipio et al., incidence of unilateral arm lymphoedema after breast cancer: systematic review and meta-analysis (Lancet Oncology 2013): https://doi.org/10.1016/S1470-2045(13)70076-7 - Bartels et al., radiotherapy or surgery of the axilla after a positive sentinel node, 10-year results of AMAROS (JCO 2023): https://doi.org/10.1200/JCO.22.01565 - Giuliano et al., axillary dissection versus no axillary dissection, 10-year results of ACOSOG Z0011 (JAMA 2017): https://doi.org/10.1001/jama.2017.11470 - de Boniface et al., omitting axillary dissection in breast cancer with sentinel-node metastases, SENOMAC (NEJM 2024): https://doi.org/10.1056/NEJMoa2313487 - Reimer et al., axillary surgery in breast cancer, primary results of the INSEMA trial (NEJM 2025): https://doi.org/10.1056/NEJMoa2412063 - Gartner et al., prevalence of and factors associated with persistent pain following breast cancer surgery (JAMA 2009): https://doi.org/10.1001/jama.2009.1568 - Moore et al., goserelin for ovarian protection during breast cancer adjuvant chemotherapy, POEMS/S0230 (NEJM 2015): https://doi.org/10.1056/NEJMoa1413204 - Lambertini et al., GnRH agonists during chemotherapy for preservation of ovarian function and fertility, individual patient-level meta-analysis of 873 patients (JCO 2018): https://doi.org/10.1200/JCO.2018.78.0858 - Dilawari et al., does scalp cooling have the same efficacy in Black patients receiving chemotherapy for breast cancer? (The Oncologist 2021): https://doi.org/10.1002/onco.13690 - Nangia et al., scalp cooling device and alopecia in women having chemotherapy for breast cancer, SCALP randomised trial (JAMA 2017): https://doi.org/10.1001/jama.2016.20939 ## Connected records - cancers: [Adolescent and young adult cancers (ages 15 to 39)](https://onco.cc/cancers/aya-cancers/), [Breast implant-associated anaplastic large cell lymphoma](https://onco.cc/cancers/breast-implant-associated-alcl/), [Carcinoma with medullary pattern (medullary breast cancer)](https://onco.cc/cancers/medullary-pattern-breast-carcinoma/), [Ductal carcinoma in situ (DCIS)](https://onco.cc/cancers/ductal-carcinoma-in-situ/), [HER2-low and HER2-ultralow metastatic breast cancer](https://onco.cc/cancers/her2-low-metastatic-breast-cancer/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Inflammatory breast 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devices (Cliniporator)](https://onco.cc/technologies/electrochemotherapy-devices/), [Electron beam therapy systems (linac electrons, total skin electron units, mobile electron IORT)](https://onco.cc/technologies/electron-beam-therapy-systems/), [Exercise during chemotherapy and radiotherapy](https://onco.cc/technologies/exercise-during-chemotherapy/), [FES PET (oestrogen receptor imaging)](https://onco.cc/technologies/fes-pet/), [Financial toxicity and financial navigation](https://onco.cc/technologies/financial-navigation/), [G8 geriatric screening tool](https://onco.cc/technologies/g8-geriatric-screening/), [Gamma probes, handheld gamma cameras and dose calibrators](https://onco.cc/technologies/gamma-probes-dose-calibrators/), [Hand-held and point-of-care ultrasound](https://onco.cc/technologies/hand-held-ultrasound/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [HRD genomic scar scores (GIS, LOH, HRDetect)](https://onco.cc/technologies/hrd-genomic-scar-scores/), [Hyperthermia systems (BSD-2000, EHY-2000, superficial and interstitial applicators)](https://onco.cc/technologies/hyperthermia-systems/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Intraoperative fluorescence and Cerenkov imaging systems (SPY, Firefly, LumiSystem, LightPath)](https://onco.cc/technologies/intraoperative-fluorescence-imaging-systems/), [Intraoperative radiotherapy (IORT)](https://onco.cc/technologies/intraoperative-radiotherapy/), [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [MRI](https://onco.cc/technologies/mri/), [MRI field strengths: 1.5 T, 3 T and 7 T](https://onco.cc/technologies/mri-field-strengths/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Nutrition support and cachexia management](https://onco.cc/technologies/oncology-nutrition/), [Oncofertility and fertility preservation](https://onco.cc/technologies/fertility-preservation/), [Oncology information and record-and-verify systems (ARIA, MOSAIQ)](https://onco.cc/technologies/oncology-information-systems/), [Oral SERDs](https://onco.cc/technologies/oral-serds/), [Parsortix label-free circulating tumour cell harvest](https://onco.cc/technologies/parsortix-ctc-harvest/), [Patient positioning and surface guidance systems (AlignRT, Catalyst, ExacTrac Dynamic)](https://onco.cc/technologies/patient-positioning-surface-guidance-systems/), [Peer support and support groups](https://onco.cc/technologies/peer-support-groups/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Prehabilitation before cancer surgery](https://onco.cc/technologies/prehabilitation/), [Proton therapy machines: cyclotrons, synchrotrons and single-room systems](https://onco.cc/technologies/proton-therapy-systems/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC)](https://onco.cc/technologies/quantitative-imaging-biomarkers/), [RAD51 foci assay (functional HRD test)](https://onco.cc/technologies/rad51-foci-assay/), [Radiotherapy QA phantoms and dosimeters (Sun Nuclear, IBA Dosimetry, PTW)](https://onco.cc/technologies/radiotherapy-qa-phantoms-dosimeters/), [Remote afterloaders for HDR brachytherapy](https://onco.cc/technologies/brachytherapy-afterloaders/), [Respiratory gating and tumour tracking systems (RPM, ABC, Calypso, Synchrony)](https://onco.cc/technologies/respiratory-gating-tumour-tracking-systems/), [Ring-gantry linacs (Halcyon, Ethos)](https://onco.cc/technologies/ring-gantry-linac/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Serum tumour markers: proper use and misuse](https://onco.cc/technologies/serum-tumour-markers/), [SPECT/CT](https://onco.cc/technologies/spect-ct/), [Strain echocardiography (global longitudinal strain)](https://onco.cc/technologies/strain-echocardiography-gls/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [TomoTherapy and Radixact (helical radiotherapy)](https://onco.cc/technologies/tomotherapy/), [Troponin and natriuretic peptide monitoring during cancer treatment](https://onco.cc/technologies/cardiac-biomarker-monitoring/), [Ultrasound](https://onco.cc/technologies/ultrasound/) - terms: [AJCC 8th edition prognostic stage for breast cancer](https://onco.cc/terms/ajcc-prognostic-stage-breast/), [Alkylating agents and therapy-related myeloid neoplasms](https://onco.cc/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/), [Alpha/beta ratio](https://onco.cc/terms/alpha-beta-ratio/), [Basal-like breast cancer](https://onco.cc/terms/basal-like/), [Bladder cancer after cyclophosphamide](https://onco.cc/terms/second-primary-bladder-after-cyclophosphamide/), [Body image after breast surgery and reconstruction](https://onco.cc/terms/body-image-after-breast-surgery/), [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Brain metastases (intracranial disease)](https://onco.cc/terms/brain-metastases/), [Breast cancer after chest radiotherapy given young](https://onco.cc/terms/second-primary-breast-after-chest-radiotherapy/), [Breast conservation or mastectomy](https://onco.cc/terms/breast-conserving-surgery-versus-mastectomy/), [Breast implant-associated anaplastic large cell lymphoma](https://onco.cc/terms/bia-alcl/), [Breast reconstruction](https://onco.cc/terms/breast-reconstruction/), [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/), [Carcinoma in situ (CIS)](https://onco.cc/terms/carcinoma-in-situ/), [Carers: what you can do and UK carer support (breast cancer)](https://onco.cc/terms/carers-breast-cancer-uk/), [Chemoprevention (tamoxifen, anastrozole, raloxifene) and ER-negative breast cancer](https://onco.cc/terms/chemoprevention-and-er-negative-breast-cancer/), [Choices made at the time of treatment that change the second cancer risk](https://onco.cc/terms/rejuv-second-choices-made-at-treatment/), [Co-amplification and the 17q12 HER2 amplicon](https://onco.cc/terms/co-amplification/), [Cording (axillary web syndrome)](https://onco.cc/terms/cording-axillary-web-syndrome/), [Core needle biopsy and fine-needle aspiration (FNA)](https://onco.cc/terms/core-needle-biopsy/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Deep inspiration breath-hold (DIBH)](https://onco.cc/terms/deep-inspiration-breath-hold/), [Doing less to the armpit](https://onco.cc/terms/axillary-surgery-de-escalation/), [Drugs before or after the operation](https://onco.cc/terms/neoadjuvant-versus-adjuvant-breast/), [Ductal carcinoma in situ (DCIS)](https://onco.cc/terms/dcis/), [Ducts, lobules and the terminal duct lobular unit](https://onco.cc/terms/terminal-duct-lobular-unit/), [ER and PR negative under 1 percent (the triple-negative threshold, and ER-low)](https://onco.cc/terms/er-pr-negative-threshold/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [FISH / ISH (in situ hybridisation)](https://onco.cc/terms/fish/), [Founder mutation (BRCA1 185delAG and 5382insC, BRCA2 6174delT)](https://onco.cc/terms/founder-mutation/), [Germline BRCA testing criteria for triple-negative breast cancer (UK)](https://onco.cc/terms/germline-brca-testing-criteria-tnbc/), [Grade](https://onco.cc/terms/tumour-grade/), [Grade versus stage](https://onco.cc/terms/grade-vs-stage/), [Grade, stage and receptor status: three different things on one breast report](https://onco.cc/terms/grade-stage-receptor-breast/), [Hair loss and scalp cooling with breast cancer chemotherapy](https://onco.cc/terms/hair-loss-and-scalp-cooling-breast/), [Health disparities in cancer outcomes (ethnicity, deprivation and access)](https://onco.cc/terms/health-disparities/), [HER2 testing in the UK: reflex ISH, the ratio against the copy number, and where the UK differs from ASCO/CAP](https://onco.cc/terms/her2-testing-uk-breast/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/), [HER2-positive (IHC 3+ or ISH-amplified)](https://onco.cc/terms/her2-positive/), [Hormone receptor status (ER / PR)](https://onco.cc/terms/hormone-receptor-status/), [How ER and PR are scored on a breast report (Allred score, H score, and why PR is not a UK core item)](https://onco.cc/terms/er-pr-scoring-breast/), [Hypofractionation (fewer, larger radiotherapy doses)](https://onco.cc/terms/hypofractionation/), [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [Interval breast cancer (a cancer found between screening rounds)](https://onco.cc/terms/interval-breast-cancer/), [Invasive disease-free survival (iDFS)](https://onco.cc/terms/idfs/), [Ki-67 in triple-negative breast cancer](https://onco.cc/terms/ki-67-in-tnbc/), [Late effects and survivorship toxicity](https://onco.cc/terms/late-effects/), [Leaving radiotherapy out](https://onco.cc/terms/radiotherapy-omission-early-breast-cancer/), [Lumpectomy (breast-conserving surgery)](https://onco.cc/terms/lumpectomy/), [Lung cancer after chest radiotherapy and after alkylating chemotherapy](https://onco.cc/terms/second-primary-lung-after-chest-radiotherapy/), [Lymph node status (node-positive / node-negative)](https://onco.cc/terms/lymph-node-status/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Lymphoedema after breast cancer treatment](https://onco.cc/terms/breast-cancer-related-lymphoedema/), [Lymphoedema after breast cancer treatment](https://onco.cc/terms/lymphoedema-after-breast-cancer/), [Lymphovascular invasion (LVI)](https://onco.cc/terms/lymphovascular-invasion/), [Margins after breast-conserving surgery, and second operations](https://onco.cc/terms/breast-margins-and-re-excision/), [Mastectomy](https://onco.cc/terms/mastectomy/), [Mechanical theory: stiffness, pressure and force as causes](https://onco.cc/terms/mechanical-theory-of-cancer/), [Menopause symptoms after chemotherapy for breast cancer](https://onco.cc/terms/menopause-after-chemotherapy-breast/), [Metastatic spinal cord compression (MSCC)](https://onco.cc/terms/metastatic-spinal-cord-compression/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/), [Neutropenic sepsis: the temperature rule and the 999 signs](https://onco.cc/terms/neutropenic-sepsis-breast-chemotherapy/), [Nottingham grade (breast cancer grade 1, 2 and 3)](https://onco.cc/terms/nottingham-grade/), [Nottingham Prognostic Index (NPI), and PREDICT](https://onco.cc/terms/nottingham-prognostic-index/), [Numbness and nerve pain after breast surgery](https://onco.cc/terms/numbness-after-breast-surgery/), [Oncoplastic breast surgery](https://onco.cc/terms/oncoplastic-breast-surgery/), [PAM50 / intrinsic subtypes](https://onco.cc/terms/pam50/), [Partial-breast irradiation](https://onco.cc/terms/partial-breast-irradiation/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Radiotherapy after mastectomy](https://onco.cc/terms/post-mastectomy-radiotherapy/), [Radiotherapy and second cancers: field, dose and age at exposure](https://onco.cc/terms/rejuv-second-radiotherapy-dose-field-and-age/), [Receptor conversion: when the receptors change between the primary and a recurrence](https://onco.cc/terms/receptor-conversion-breast/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Residual cancer burden (RCB)](https://onco.cc/terms/rcb/), [Risk-reducing surgery for BRCA carriers (bilateral and contralateral mastectomy, salpingo-oophorectomy)](https://onco.cc/terms/risk-reducing-surgery-brca-carriers/), [Sarcoma in the radiotherapy field, and angiosarcoma of the treated breast](https://onco.cc/terms/second-primary-sarcoma-in-the-treated-field/), [Screening survivors: where the UK, American and European answers differ](https://onco.cc/terms/rejuv-second-screening-after-treatment-compared/), [Seed and soil hypothesis of metastasis (Paget)](https://onco.cc/terms/seed-and-soil-hypothesis/), [Sentinel node biopsy](https://onco.cc/terms/sentinel-lymph-node-biopsy/), [Seroma after breast surgery](https://onco.cc/terms/seroma-after-breast-surgery/), [Stage](https://onco.cc/terms/cancer-stage/), [Targeted axillary dissection](https://onco.cc/terms/targeted-axillary-dissection/), [The UK very high risk breast screening protocol after chest radiotherapy](https://onco.cc/terms/rejuv-second-uk-very-high-risk-breast-screening/), [The WHO classification of breast tumours, and what the 6th edition changed](https://onco.cc/terms/who-breast-classification/), [Thyroid cancer after neck radiotherapy, and whether to look for it](https://onco.cc/terms/second-primary-thyroid-after-neck-radiotherapy/), [TNM staging](https://onco.cc/terms/tnm-staging/), [Tumour bed boost](https://onco.cc/terms/tumour-bed-boost/), [Tumour size on a breast report, and why it differs from the scan](https://onco.cc/terms/breast-tumour-size-on-the-report/), [What is not a second cancer: recurrence, metastasis and field cancerisation](https://onco.cc/terms/rejuv-second-what-is-not-a-second-cancer/), [Which staging edition a breast report uses: UICC TNM 8, TNM 9 and the AJCC prognostic stage](https://onco.cc/terms/tnm-breast-cancer-editions/), [Work and money during breast cancer treatment (UK)](https://onco.cc/terms/work-and-money-breast-cancer-uk/) - trials: [[18F]Fluoroestradiol-PET/CT Imaging of Invasive Lobular Carcinoma](https://onco.cc/trials/nct04252859/), [[68Ga]Ga-ABY-025 PET for Quantification of HER2-status in Solid Tumors](https://onco.cc/trials/nct05619016/), [18F-fluoroestradiol (FES) PET/CT for Breast Cancer](https://onco.cc/trials/nct04883814/), [A Phase 3, Multi-Center Study of Gemcitabine/Carboplatin, With or Without BSI-201, in Patients With ER-, PR-, and Her2-Negative Metastatic Breast Cancer](https://onco.cc/trials/nct00938652/), [A Study of Enzalutamide, Enzalutamide in Combination With Mifepristone, or Chemotherapy in People With Metastatic Breast Cancer](https://onco.cc/trials/nct06099769/), [A Study of Poziotinib in Patients With Epidermal Growth Factor Receptor (EGFR) or Human Epidermal Growth Factor Receptor 2 (HER2) Activating Mutations in Advanced Malignancies](https://onco.cc/trials/nct04172597/), [A Study to Allow Continued Dosing and/or Follow-up of Patients Who Have Had Previous Exposure to Poziotinib](https://onco.cc/trials/nct03744715/), [Abraxane® With or Without Mifepristone for Advanced, Glucocorticoid Receptor-Positive, Triple-Negative Breast Cancer](https://onco.cc/trials/nct02788981/), [ACCELERATE: Doxorubicin and Cyclophosphamide Followed by Paclitaxel With Pegfilgrastim and Darbepoetin Alfa Support for the Treatment of Women With Breast Cancer](https://onco.cc/trials/nct00261313/), [ACOSOG Z0011 (Alliance)](https://onco.cc/trials/acosog-z0011/), [ACOSOG Z1071 (Alliance)](https://onco.cc/trials/acosog-z1071/), [Adding Capivasertib to Standard Treatment in HR Positive, HER2 Negative Metastatic Breast Cancer Based on ctDNA Testing](https://onco.cc/trials/nct07802626/), [Adjuvant Toremifene With or Without Goserrelin in Premenopausal Women With Stage I-IIIA, Hormonal Receptor Positive Breast Cancer Accompanied With or Without Chemotherapy Induced Amenorrhoea](https://onco.cc/trials/nct02132390/), [AgeX](https://onco.cc/trials/agex/), [AKY15-HK-301_NEPA Study](https://onco.cc/trials/nct03386617/), [ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance)](https://onco.cc/trials/almanac/), [AMAROS (EORTC 10981-22023)](https://onco.cc/trials/amaros/), [ATEMPT](https://onco.cc/trials/atempt/), [ATNEC](https://onco.cc/trials/atnec/), [Best-BRA](https://onco.cc/trials/best-bra/), [BOLERO-2](https://onco.cc/trials/bolero-2/), [Breast and Melanoma Trial With Lymphoseek to Identify Lymph Nodes](https://onco.cc/trials/nct01106040/), [Breast Cancer With Intraoperative Radiotherapy Followed by Hypofractionated External Beam Radiotherapy](https://onco.cc/trials/nct05498311/), [Calcium and Magnesium in Preventing Peripheral Neuropathy Caused by Ixabepilone in Patients With Breast Cancer](https://onco.cc/trials/nct00998738/), [CALGB 9343](https://onco.cc/trials/calgb-9343/), [CanWork: an occupational therapy programme to help women return to work after breast cancer](https://onco.cc/trials/rejuv-trial-canwork/), [Chemotherapy With or Without Trastuzumab After Surgery in Treating Women With Invasive Breast Cancer](https://onco.cc/trials/nct01275677/), [Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy](https://onco.cc/trials/nct01091974/), [Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab in Treating Women With Stage III or Stage IV Breast Cancer](https://onco.cc/trials/nct00016276/), [COMET (Comparison of Operative versus Monitoring and Endocrine Therapy)](https://onco.cc/trials/comet-dcis/), [Comparative Study of Scalp Cooling System and Chemical Cold Cap (COHAIR Study)](https://onco.cc/trials/nct03711877/), [Contrast-Enhanced Spectral Mammography (CESM)](https://onco.cc/trials/nct06311695/), [Cryoablation Versus Lumpectomy in Early-Stage Breast Cancer](https://onco.cc/trials/nct07483996/), [Diagnostic Accuracy and Safety Study of FES PET/CT in Assessment of ER Status of Recurrent or Metastatic Breast Cancer](https://onco.cc/trials/nct01986569/), [Docetaxel, Carboplatin, Trastuzumab, and Pertuzumab With or Without Estrogen Deprivation in Treating Patients With Hormone Receptor-Positive, HER2-Positive Operable or Locally Advanced Breast Cancer](https://onco.cc/trials/nct02003209/), [Efficacy of Tamoxifen Versus Toremifene in CYP2D6 IM/PM of Premenopausal Patients With ER-positive Early Breast Cancer](https://onco.cc/trials/nct03351062/), [Electrochemotherapy for Chest Wall Recurrence af Breast Cancer: Present Challenges and Future Prospects](https://onco.cc/trials/nct00744653/), [EORTC 10801](https://onco.cc/trials/eortc-10801/), [EORTC 22881-10882 (boost against no boost)](https://onco.cc/trials/eortc-22881-boost/), [EORTC 22922/10925](https://onco.cc/trials/eortc-22922/), [Evaluate the Use of Paravertebral Block in Reconstructive Breast Surgery](https://onco.cc/trials/nct00542542/), [FAST (5-fraction whole-breast radiotherapy)](https://onco.cc/trials/fast-trial/), [FAST-Forward](https://onco.cc/trials/fast-forward/), [FES PET/CT in Predicting Response in Patients With Newly Diagnosed Metastatic Breast Cancer Receiving Endocrine Therapy](https://onco.cc/trials/nct02398773/), [GeparSixto](https://onco.cc/trials/geparsixto/), [HOBOE: A Phase 3 Study of Adjuvant Triptorelin and Tamoxifen, Letrozole, or Letrozole and Zoledronic Acid in Premenopausal Patients With Breast Cancer](https://onco.cc/trials/nct00412022/), [I-SPY 1 (CALGB 150007/150012, ACRIN 6657)](https://onco.cc/trials/i-spy-1/), [I-SPY 2](https://onco.cc/trials/i-spy-2/), [I-SPY 2.2](https://onco.cc/trials/i-spy-2-2/), [Ibandronate or Zoledronate in Treating Patients With Newly Diagnosed Bone Metastases From Breast Cancer](https://onco.cc/trials/nct00326820/), [IBCSG 23-01](https://onco.cc/trials/ibcsg-23-01/), [IBIS-I (International Breast Intervention Study I)](https://onco.cc/trials/ibis-i/), [IBIS-II (International Breast Intervention Study II)](https://onco.cc/trials/ibis-ii/), [iBRA (implant Breast Reconstruction evAluation)](https://onco.cc/trials/ibra-study/), [Implementing Geriatric Assessment for Dose Optimization of Cyclin-dependent Kinase (CDK) 4/6-inhibitors in Older Breast Cancer Patients](https://onco.cc/trials/nct06044623/), [IMPORT LOW](https://onco.cc/trials/import-low/), [Inetetamab Plus Rapamycin and Chemotherapy for HER2+ Metastatic Breast Cancer With Abnormal Activation of PAM Pathway](https://onco.cc/trials/nct04736589/), [INSEMA (Intergroup Sentinel Mamma)](https://onco.cc/trials/insema/), [Interleukin-11 Plus Filgrastim Prior to Peripheral Stem Cell Transplantation in Patients With Non-Hodgkin's Lymphoma, Hodgkin's Disease, Breast Cancer, or Other Solid Tumors](https://onco.cc/trials/nct00004157/), [Intraoperative Radiotherapy for Korean Patients With Breast Cancer](https://onco.cc/trials/nct02213991/), [Investigating the Potential Role of a Novel Quadrate Combination Therapy Mifepristone(Antiprogestrone), Tamoxifen, Retinoic Acid and Cannabidiol ( Selective Cyp 26 Inhibitor) for Treating Early Breast Cancer](https://onco.cc/trials/nct05016349/), [LUMINA](https://onco.cc/trials/lumina/), [MARGetuximab Or Trastuzumab (MARGOT)](https://onco.cc/trials/nct04425018/), [Margetuximab Plus Chemotherapy vs Trastuzumab Plus Chemotherapy in the Treatment of HER2+ Metastatic Breast Cancer](https://onco.cc/trials/nct02492711/), [Mastectomy Reconstruction Outcomes Consortium (MROC)](https://onco.cc/trials/mroc/), [Mecapegfilgrastim for the Prevention of Dalpiciclib -Induced Neutropenia in Advanced Breast Cancer](https://onco.cc/trials/nct05463601/), [Milan I (quadrantectomy against radical mastectomy)](https://onco.cc/trials/milan-i/), [Mithramycin for Lung, Esophagus, and Other Chest Cancers](https://onco.cc/trials/nct01624090/), [NALA](https://onco.cc/trials/nala/), [NCIC MA.20](https://onco.cc/trials/ma-20/), [Neulasta-controlled Trial of F-627 in Women With Breast Cancer Receiving Myelotoxic Chemotherapy](https://onco.cc/trials/nct03252431/), [NSABP B-04](https://onco.cc/trials/nsabp-b04/), [NSABP B-06](https://onco.cc/trials/nsabp-b06/), [NSABP B-32](https://onco.cc/trials/nsabp-b32/), [NSABP B-39/RTOG 0413](https://onco.cc/trials/nsabp-b39/), [NSABP B-51 / RTOG 1304](https://onco.cc/trials/nsabp-b51/), [Optimization of Dynamic Neoadjuvant Therapy Strategies for HER2-Positive Breast Cancer Based on HER2-PET/CT Molecular Imaging](https://onco.cc/trials/nct07527806/), [PATINA](https://onco.cc/trials/patina/), [PENELOPE-B](https://onco.cc/trials/penelope-b/), [Phytocannabinoids for Reducing Chronic Chemotherapy-Induced Peripheral Neuropathy in Breast and Colon Cancer Survivors](https://onco.cc/trials/nct06731894/), [Pilocarpine in Treating Vaginal Dryness in Patients With Breast Cancer](https://onco.cc/trials/nct00343382/), [Pixantrone Dimaleate in Treating Patients With HER2-Negative Metastatic Breast Cancer](https://onco.cc/trials/nct01086605/), [Placebo-controlled Trial of F-627 in Women With Breast Cancer Receiving Myelotoxic Chemotherapy](https://onco.cc/trials/nct02872103/), [plasmaMATCH](https://onco.cc/trials/plasmamatch/), [POSNOC](https://onco.cc/trials/posnoc/), [Pre-BRA (pre-pectoral breast reconstruction evaluation)](https://onco.cc/trials/pre-bra/), [Prevention of Persistent Alopecia Following Docetaxel by Means of Scalp Cooling](https://onco.cc/trials/nct00515762/), [PRIME II](https://onco.cc/trials/prime-ii/), [PROFFi: fisetin and exercise to prevent frailty in breast cancer survivors](https://onco.cc/trials/rejuv-trial-proffi/), [Propranolol and Pembrolizumab for Tumor Re-sensitization and Treatment of Patients With Checkpoint Inhibitor Refractory Metastatic or Unresectable Triple Negative Breast Cancer](https://onco.cc/trials/nct05741164/), [Pyrotinib and Vinorelbine Tartrate Capsules With or Without Inetetamab for First Line Treatment in Patients With Trastuzumab-resistant HER2-positive Advanced Breast Cancer](https://onco.cc/trials/nct04963595/), [Randomized Phase III Trial Comparing Sequential Administration of FE75C Followed by Docetaxel Versus Paclitaxel as Adjuvant Chemotherapy in Axillary Lymph Node (+) Breast Cancer](https://onco.cc/trials/nct00431080/), [RAPID (accelerated partial-breast irradiation)](https://onco.cc/trials/rapid/), [RC48 Combined With Chemotherapy in HER2-Positive Advanced Breast Cancer Patients With Prior TOP1i-ADC Failure](https://onco.cc/trials/nct07366840/), [Safety and Efficacy Comparison of Docetaxel and Ixabepilone in Non Metastatic Poor Prognosis Breast Cancer](https://onco.cc/trials/nct00630032/), [Scalp Cooling in MBC](https://onco.cc/trials/nct04986579/), [SCAN-B (Sweden Cancerome Analysis Network - Breast)](https://onco.cc/trials/scan-b/), [SENOMAC](https://onco.cc/trials/senomac/), [Sentinel and/or Axillary Lymph Node Biopsy With or Without Axillary Reverse Mapping in Reducing Incidence and Severity of Arm Lymphedema in Stage 0-2 Patients](https://onco.cc/trials/nct01276054/), [Sequential Administration of FE75C and Docetaxel Versus Docetaxel/Cyclophosphamide in HER-2 Negative, Node Positive Breast Cancer](https://onco.cc/trials/nct01985724/), [Serial FES PET/CT to Measure Hormone Expression in Patients Undergoing Endocrine Targeted Therapy](https://onco.cc/trials/nct04692103/), [Shark Cartilage in Treating Patients With Advanced Colorectal or Breast Cancer](https://onco.cc/trials/nct00026117/), [Six vs 12 Months of Trastuzumab With Docetaxel Following FEC as Adjuvant Treatment in N+ Breast Cancer](https://onco.cc/trials/nct00615602/), [SOUND (Sentinel Node vs Observation After Axillary Ultra-Sound)](https://onco.cc/trials/sound/), [START-A (UK Standardisation of Breast Radiotherapy, trial A)](https://onco.cc/trials/start-a/), [START-B (UK Standardisation of Breast Radiotherapy)](https://onco.cc/trials/start-b/), [Stereotactic Body Radiation Therapy and FES PET/CT Imaging for the Treatment of Oligoprogressive Estrogen Receptor Positive Metastatic Breast Cancer](https://onco.cc/trials/nct06260033/), [Study of Dotatate Imaging in Breast Cancer](https://onco.cc/trials/nct05880394/), [Study of Poziotinib in Participants With HER2-Positive Metastatic Breast Cancer](https://onco.cc/trials/nct02659514/), [Study of SAR240550 (BSI-201) in Combination With Gemcitabine/Carboplatin, in Patients With Metastatic Triple Negative Breast Cancer](https://onco.cc/trials/nct01045304/), [Study on Using TROP2-PET and 18F-FDG PET to Predict the Efficacy of Anti TROP2 ADC Treatment in Advanced Breast Cancer](https://onco.cc/trials/nct07471776/), [Study to Compare the Efficacy and Safety of F-627 and GRAN®](https://onco.cc/trials/nct04174599/), [SUPREMO (BIG 2-04)](https://onco.cc/trials/supremo/), [SYD985 vs. Physician's Choice in Participants With HER2-positive Locally Advanced or Metastatic Breast Cancer](https://onco.cc/trials/nct03262935/), [TAM-01](https://onco.cc/trials/tam-01/), [TAPUR (Targeted Agent and Profiling Utilization Registry)](https://onco.cc/trials/tapur/), [Targeted axillary dissection (MD Anderson prospective study)](https://onco.cc/trials/targeted-axillary-dissection-md-anderson/), [TARGIT-A (targeted intraoperative radiotherapy)](https://onco.cc/trials/targit-a/), [Technetium Tc 99m Sulfur Colloid Injection for Tracing Sentinel Nodes in Breast Cancer](https://onco.cc/trials/nct07764653/), [The PRECISION Trial (Profiling Early Breast Cancer for Radiotherapy Omission): A Phase II Study of Breast-Conserving Surgery Without Adjuvant Radiotherapy for Favorable-Risk Breast Cancer](https://onco.cc/trials/nct02653755/), [Treatment of Refractory Nausea and Vomiting in Patients With Breast Cancer](https://onco.cc/trials/nct03367572/), [Trial of Lymphoseek in Intraoperative Localization of Lymph Nodes in Breast Cancer and Melanoma](https://onco.cc/trials/nct00671918/), [Triptorelin With Either Exemestane or Tamoxifen in Treating Premenopausal Women With Hormone-Responsive Breast Cancer](https://onco.cc/trials/nct00066703/), [Tusamitamab Ravtansine Monotherapy and in Combination in Patients With CEACAM5-positive Advanced Solid Tumors](https://onco.cc/trials/nct04659603/), [TUXEDO-1](https://onco.cc/trials/tuxedo-1/), [Two Regimens of SAR240550/Weekly Paclitaxel and Paclitaxel Alone as Neoadjuvant Therapy in Triple Negative Breast Cancer Patients](https://onco.cc/trials/nct01204125/), [WISDOM (Women Informed to Screen Depending on Measures of Risk)](https://onco.cc/trials/wisdom-trial/), [XM22-03](https://onco.cc/trials/xm22-03/) - drugs: [Datopotamab deruxtecan](https://onco.cc/drugs/datopotamab-deruxtecan/), [Nab-paclitaxel](https://onco.cc/drugs/nab-paclitaxel/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/) - key papers: [A high prevalence of BRCA1 mutations among breast cancer patients from the Bahamas](https://onco.cc/key-papers/paper-donenberg-bahamas-brca1-founder-bcrt-2011/), [Assessment of molecular relapse detection in early-stage breast cancer](https://onco.cc/key-papers/paper-garcia-murillas-molecular-relapse-detection-jama-oncol-2019/), [Circulating tumor DNA in neoadjuvant-treated breast cancer reflects response and survival](https://onco.cc/key-papers/paper-magbanua-ispy2-ctdna-neoadjuvant-ann-oncol-2021/), [Comparison of breast cancer molecular features and survival by African and European ancestry in The Cancer Genome Atlas](https://onco.cc/key-papers/paper-huo-tcga-ancestry-breast-jama-oncol-2017/), [Comprehensive molecular portraits of human breast tumours](https://onco.cc/key-papers/paper-tcga-breast-molecular-portraits-nature-2012/), [Efficacy and safety of lipegfilgrastim versus pegfilgrastim in breast cancer patients receiving doxorubicin and docetaxel (XM22-03)](https://onco.cc/key-papers/paper-xm22-03-bondarenko-bmc-cancer-2013/), [Germline testing in patients with breast cancer: ASCO-Society of Surgical Oncology guideline](https://onco.cc/key-papers/paper-bedrosian-asco-sso-germline-testing-breast-jco-2024/), [HRDetect is a predictor of BRCA1 and BRCA2 deficiency based on mutational signatures](https://onco.cc/key-papers/paper-davies-nat-med/), [Implementation and audit of mainstream genetic testing within a high-volume UK breast unit for pathogenic variations associated with breast cancer using the R208 and R444.1 National Test Directory criterion](https://onco.cc/key-papers/paper-conroy-nhs-r208-mainstream-testing-audit-breast-j-2026/), [Inherited breast cancer in Nigerian women](https://onco.cc/key-papers/paper-zheng-nigerian-inherited-breast-cancer-jco-2018/), [Mutation tracking in circulating tumor DNA predicts relapse in early breast cancer](https://onco.cc/key-papers/paper-garcia-murillas-ctdna-mutation-tracking-stm-2015/), [Prevalence and mutational determinants of high tumor mutation burden in breast cancer](https://onco.cc/key-papers/paper-barroso-sousa-breast-tmb-prevalence-ann-oncol-2020/), [The functional loss of the retinoblastoma tumour suppressor is a common event in basal-like and luminal B breast carcinomas](https://onco.cc/key-papers/paper-herschkowitz-rb1-loss-basal-like-bcr-2008/), [The impact of expanded access to germline high penetrance genetic testing for women with a new diagnosis of invasive breast cancer or high-grade DCIS](https://onco.cc/key-papers/paper-hudson-phillips-expanded-germline-testing-clin-breast-cancer-2026/), [The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews](https://onco.cc/key-papers/paper-struewing-brca-founder-mutations-ashkenazi-nejm-1997/), [Tumour-infiltrating lymphocytes and prognosis in different subtypes of breast cancer: a pooled analysis of 3771 patients treated with neoadjuvant therapy](https://onco.cc/key-papers/paper-denkert-tils-neoadjuvant-pooled-lancet-oncol-2018/) - institutions: [Breast Cancer Now](https://onco.cc/institutions/breast-cancer-now/) - people: [Andrea DeCensi](https://onco.cc/people/andrea-decensi/), [Anne Armstrong](https://onco.cc/people/anne-armstrong/), [E. Shelley Hwang](https://onco.cc/people/shelley-hwang/), [Ellen Copson](https://onco.cc/people/ellen-copson/), [Frédérique Penault-Llorca](https://onco.cc/people/frederique-penault-llorca/), [José Baselga](https://onco.cc/people/jose-baselga/), [Joseph Gligorov](https://onco.cc/people/joseph-gligorov/), [Mario Campone](https://onco.cc/people/mario-campone/), [Mark E. Burkard](https://onco.cc/people/mark-burkard/), [Mark E. Robson](https://onco.cc/people/mark-robson/), [Naoto T. Ueno](https://onco.cc/people/naoto-ueno/), [Rashmi K. Murthy](https://onco.cc/people/rashmi-murthy/), [Rupert Bartsch](https://onco.cc/people/rupert-bartsch/) - collections: [Australia's national cancer screening programs](https://onco.cc/collections/australia-cancer-screening-programs/), [Breast Cancer Now helpline](https://onco.cc/collections/breast-cancer-now-helpline/), [CDC National Breast and Cervical Cancer Early Detection Program](https://onco.cc/collections/cdc-nbccedp/), [Ireland's National Screening Service](https://onco.cc/collections/ireland-national-screening-service/), [Knitted Knockers](https://onco.cc/collections/knitted-knockers/), [NHS cancer screening programmes](https://onco.cc/collections/nhs-cancer-screening-programmes/), [NHS Jewish BRCA Testing Programme](https://onco.cc/collections/nhs-jewish-brca-testing/), [Sharsheret](https://onco.cc/collections/sharsheret/), [Time to Screen (New Zealand national screening)](https://onco.cc/collections/nz-time-to-screen/), [Triple Negative Breast Cancer Foundation](https://onco.cc/collections/src-tnbc-foundation/) - bottlenecks: [No randomised trial shows that any survivorship screening programme reduces death](https://onco.cc/bottlenecks/rejuv-agenda-screening-without-a-trial/) - biomarkers: [ctDNA MRD positivity (molecular residual disease after curative treatment)](https://onco.cc/biomarkers/ctdna-mrd-positive/), [ER status (oestrogen receptor by IHC)](https://onco.cc/biomarkers/er-status/), [Germline BRCA1/2 pathogenic variant (gBRCAm)](https://onco.cc/biomarkers/brca-germline/), [HER2 IHC 0 (HER2-negative, including ultralow)](https://onco.cc/biomarkers/her2-ihc-0/), [HER2 IHC 1+](https://onco.cc/biomarkers/her2-ihc-1-plus/), [HER2 IHC 2+ (equivocal, reflex to ISH)](https://onco.cc/biomarkers/her2-ihc-2-plus/), [HER2-low (IHC 1+ or IHC 2+/ISH-negative)](https://onco.cc/biomarkers/her2-low-ihc/), [HER3 expression](https://onco.cc/biomarkers/her3-expression/), [PR status (progesterone receptor by IHC)](https://onco.cc/biomarkers/pr-status/) - companies: [ANGLE plc](https://onco.cc/companies/angle-plc/), [Butterfly Network](https://onco.cc/companies/butterfly-network/), [Carl Zeiss Meditec](https://onco.cc/companies/carl-zeiss-meditec/), [Dignitana](https://onco.cc/companies/dignitana/), [Hellenic Oncology Research Group](https://onco.cc/companies/horg/), [IceCure Medical](https://onco.cc/companies/icecure-medical/), [IGEA](https://onco.cc/companies/igea/), [intoDNA](https://onco.cc/companies/intodna/), [Lightpoint Medical](https://onco.cc/companies/lightpoint-medical/), [Mammotome (Danaher)](https://onco.cc/companies/mammotome/), [Menarini Silicon Biosystems](https://onco.cc/companies/menarini-silicon-biosystems/), [Paxman](https://onco.cc/companies/paxman/), [Pyrexar Medical](https://onco.cc/companies/pyrexar-medical/), [Quantum Leap Healthcare Collaborative](https://onco.cc/companies/quantum-leap-healthcare-collaborative/), [Strata Oncology](https://onco.cc/companies/strata-oncology/) - targets: [ABCB1](https://onco.cc/targets/abcb1/), [ABCC1](https://onco.cc/targets/abcc1/), [ABCC3](https://onco.cc/targets/abcc3/), [ABI1](https://onco.cc/targets/abi1/), [ABL2](https://onco.cc/targets/abl2/), [ACVR1B](https://onco.cc/targets/acvr1b/), [ADAM29](https://onco.cc/targets/adam29/), [AFDN](https://onco.cc/targets/afdn/), [AFF3](https://onco.cc/targets/aff3/), [AFF4](https://onco.cc/targets/aff4/), [AGR2](https://onco.cc/targets/agr2/), [AKAP9](https://onco.cc/targets/akap9/), [ARHGAP26](https://onco.cc/targets/arhgap26/), [ARHGAP35](https://onco.cc/targets/arhgap35/), [ARHGEF12](https://onco.cc/targets/arhgef12/), [ARHGEF5](https://onco.cc/targets/arhgef5/), [ARID1A](https://onco.cc/targets/arid1a/), [ARID1B](https://onco.cc/targets/arid1b/), [ARNT](https://onco.cc/targets/arnt/), [ASXL1](https://onco.cc/targets/asxl1/), [ATM](https://onco.cc/targets/atm/), [ATP1A1](https://onco.cc/targets/atp1a1/), [ATP2B3](https://onco.cc/targets/atp2b3/), [ATRX](https://onco.cc/targets/atrx/), [BAP1](https://onco.cc/targets/bap1/), [BARD1](https://onco.cc/targets/bard1/), [BCL11A](https://onco.cc/targets/bcl11a/), [BCL11B](https://onco.cc/targets/bcl11b/), [BCL9](https://onco.cc/targets/bcl9/), [BCORL1](https://onco.cc/targets/bcorl1/), [BIRC6](https://onco.cc/targets/birc6/), [BLM](https://onco.cc/targets/blm/), [BMPR1A](https://onco.cc/targets/bmpr1a/), [BRIP1](https://onco.cc/targets/brip1/), [BUB1B](https://onco.cc/targets/bub1b/), [C11orf65](https://onco.cc/targets/c11orf65/), [CACNA1D](https://onco.cc/targets/cacna1d/), [CAMTA1](https://onco.cc/targets/camta1/), [CASP8](https://onco.cc/targets/casp8/), [CBFA2T3](https://onco.cc/targets/cbfa2t3/), [CBFB](https://onco.cc/targets/cbfb/), [CBLB](https://onco.cc/targets/cblb/), [CBLC](https://onco.cc/targets/cblc/), [CCDC170](https://onco.cc/targets/ccdc170/), [CCND1](https://onco.cc/targets/ccnd1/), [CCND3](https://onco.cc/targets/ccnd3/), [CCNE1](https://onco.cc/targets/ccne1/), [CCNE2](https://onco.cc/targets/ccne2/), [CD209](https://onco.cc/targets/cd209/), [CDC73](https://onco.cc/targets/cdc73/), [CDH1](https://onco.cc/targets/cdh1/), [CDH11](https://onco.cc/targets/cdh11/), [CDK12](https://onco.cc/targets/cdk12/), [CDKN1A](https://onco.cc/targets/cdkn1a/), [CDKN1B](https://onco.cc/targets/cdkn1b/), [CDKN2B](https://onco.cc/targets/cdkn2b/), [CHEK2](https://onco.cc/targets/chek2/), [CLTC](https://onco.cc/targets/cltc/), [CLTCL1](https://onco.cc/targets/cltcl1/), [CREB1](https://onco.cc/targets/creb1/), [CREB3L1](https://onco.cc/targets/creb3l1/), [CREB3L2](https://onco.cc/targets/creb3l2/), [CREBBP](https://onco.cc/targets/crebbp/), [CSMD3](https://onco.cc/targets/csmd3/), [CSPG4](https://onco.cc/targets/cspg4/), [CTCF](https://onco.cc/targets/ctcf/), [CUX1](https://onco.cc/targets/cux1/), [CYLD](https://onco.cc/targets/cyld/), [CYP2D6](https://onco.cc/targets/cyp2d6/), [DDX10](https://onco.cc/targets/ddx10/), [DDX3X](https://onco.cc/targets/ddx3x/), [DEK](https://onco.cc/targets/dek/), [DNAJC12](https://onco.cc/targets/dnajc12/), [DNM2](https://onco.cc/targets/dnm2/), [DROSHA](https://onco.cc/targets/drosha/), [EBF1](https://onco.cc/targets/ebf1/), [EIF3E](https://onco.cc/targets/eif3e/), [EIF4A2](https://onco.cc/targets/eif4a2/), [ELF4](https://onco.cc/targets/elf4/), [ELL](https://onco.cc/targets/ell/), [ELN](https://onco.cc/targets/eln/), [EPHA3](https://onco.cc/targets/epha3/), [EPS15](https://onco.cc/targets/eps15/), [ESR2](https://onco.cc/targets/esr2/), [ETNK1](https://onco.cc/targets/etnk1/), [ETV1](https://onco.cc/targets/etv1/), [ETV5](https://onco.cc/targets/etv5/), [ETV6](https://onco.cc/targets/etv6/), [EXO1](https://onco.cc/targets/exo1/), [EXT1](https://onco.cc/targets/ext1/), [EXT2](https://onco.cc/targets/ext2/), [FANCC](https://onco.cc/targets/fancc/), [FANCD2](https://onco.cc/targets/fancd2/), [FANCM](https://onco.cc/targets/fancm/), [FAT1](https://onco.cc/targets/fat1/), [FAT3](https://onco.cc/targets/fat3/), [FAT4](https://onco.cc/targets/fat4/), [FBXO11](https://onco.cc/targets/fbxo11/), [FBXW7](https://onco.cc/targets/fbxw7/), [FCGR2A](https://onco.cc/targets/fcgr2a/), [FCGR2B](https://onco.cc/targets/fcgr2b/), [FCGR3A](https://onco.cc/targets/fcgr3a/), [FCRL4](https://onco.cc/targets/fcrl4/), [FDPS](https://onco.cc/targets/fdps/), [FGF3](https://onco.cc/targets/fgf3/), [FGFR4](https://onco.cc/targets/fgfr4/), [FHIT](https://onco.cc/targets/fhit/), [FOXA1](https://onco.cc/targets/foxa1/), [FOXO3](https://onco.cc/targets/foxo3/), [FOXP1](https://onco.cc/targets/foxp1/), [FOXP3](https://onco.cc/targets/foxp3/), [FTO](https://onco.cc/targets/fto/), [FUBP1](https://onco.cc/targets/fubp1/), [GATA3](https://onco.cc/targets/gata3/), [GNAQ](https://onco.cc/targets/gnaq/), [GNAS](https://onco.cc/targets/gnas/), [GRB7](https://onco.cc/targets/grb7/), [GRHL2](https://onco.cc/targets/grhl2/), [GRIN2A](https://onco.cc/targets/grin2a/), [H3C2](https://onco.cc/targets/h3c2/), [HDAC9](https://onco.cc/targets/hdac9/), [HIP1](https://onco.cc/targets/hip1/), [HMGA2](https://onco.cc/targets/hmga2/), [HOXC13](https://onco.cc/targets/hoxc13/), [HRAS](https://onco.cc/targets/hras/), [HSP90AA1](https://onco.cc/targets/hsp90aa1/), [IKBKB](https://onco.cc/targets/ikbkb/), [KAT6A](https://onco.cc/targets/kat6a/), [KAT6B](https://onco.cc/targets/kat6b/), [KDM6A](https://onco.cc/targets/kdm6a/), [KLF4](https://onco.cc/targets/klf4/), [KLLN](https://onco.cc/targets/klln/), [KMT2C](https://onco.cc/targets/kmt2c/), [KMT5A](https://onco.cc/targets/kmt5a/), [KNL1](https://onco.cc/targets/knl1/), [L3MBTL3](https://onco.cc/targets/l3mbtl3/), [LATS1](https://onco.cc/targets/lats1/), [LATS2](https://onco.cc/targets/lats2/), [LEF1](https://onco.cc/targets/lef1/), [LMO2](https://onco.cc/targets/lmo2/), [LPP](https://onco.cc/targets/lpp/), [LRP1B](https://onco.cc/targets/lrp1b/), [LSP1](https://onco.cc/targets/lsp1/), [LZTR1](https://onco.cc/targets/lztr1/), [MAML2](https://onco.cc/targets/maml2/), [MAP2K4](https://onco.cc/targets/map2k4/), [MAP3K1](https://onco.cc/targets/map3k1/), [MAP3K13](https://onco.cc/targets/map3k13/), [MAPK1](https://onco.cc/targets/mapk1/), [MAX](https://onco.cc/targets/max/), [MDM4](https://onco.cc/targets/mdm4/), [MECOM](https://onco.cc/targets/mecom/), [MED23](https://onco.cc/targets/med23/), [MIEN1](https://onco.cc/targets/mien1/), [MITF](https://onco.cc/targets/mitf/), [MLH1](https://onco.cc/targets/mlh1/), [MLLT10](https://onco.cc/targets/mllt10/), [MN1](https://onco.cc/targets/mn1/), [MRE11](https://onco.cc/targets/mre11/), [MRTFA](https://onco.cc/targets/mrtfa/), [MSH2](https://onco.cc/targets/msh2/), [MSH6](https://onco.cc/targets/msh6/), [MSI2](https://onco.cc/targets/msi2/), [MTCP1](https://onco.cc/targets/mtcp1/), [MUTYH](https://onco.cc/targets/mutyh/), [MYB](https://onco.cc/targets/myb/), [MYC](https://onco.cc/targets/myc-gene/), [MYD88](https://onco.cc/targets/myd88/), [MYH11](https://onco.cc/targets/myh11/), [MYH9](https://onco.cc/targets/myh9/), [MYO5A](https://onco.cc/targets/myo5a/), [NBEA](https://onco.cc/targets/nbea/), [NBN](https://onco.cc/targets/nbn/), [NCOA2](https://onco.cc/targets/ncoa2/), [NCOA3](https://onco.cc/targets/ncoa3/), [NCOR1](https://onco.cc/targets/ncor1/), [NCOR2](https://onco.cc/targets/ncor2/), [NDRG1](https://onco.cc/targets/ndrg1/), [NEK10](https://onco.cc/targets/nek10/), [NF2](https://onco.cc/targets/nf2/), [NFATC2](https://onco.cc/targets/nfatc2/), [NFIB](https://onco.cc/targets/nfib/), [NOTCH2](https://onco.cc/targets/notch2/), [NRG1](https://onco.cc/targets/nrg1/), [NRIP1](https://onco.cc/targets/nrip1/), [NSD2](https://onco.cc/targets/nsd2/), [NSD3](https://onco.cc/targets/nsd3/), [NT5C2](https://onco.cc/targets/nt5c2/), [NUMA1](https://onco.cc/targets/numa1/), [NUP98](https://onco.cc/targets/nup98/), [PALB2](https://onco.cc/targets/palb2/), [PARP2](https://onco.cc/targets/parp2/), [PAX5](https://onco.cc/targets/pax5/), [PBX1](https://onco.cc/targets/pbx1/), [PDCD1LG2](https://onco.cc/targets/pdcd1lg2/), [PGAP3](https://onco.cc/targets/pgap3/), [PHF6](https://onco.cc/targets/phf6/), [PIK3CB](https://onco.cc/targets/pik3cb/), [PIK3R1](https://onco.cc/targets/pik3r1/), [PIK3R3](https://onco.cc/targets/pik3r3/), [PLAG1](https://onco.cc/targets/plag1/), [PMS2](https://onco.cc/targets/pms2/), [PNMT](https://onco.cc/targets/pnmt/), [POLA2](https://onco.cc/targets/pola2/), [POLD1](https://onco.cc/targets/pold1/), [POLD2](https://onco.cc/targets/pold2/), [POLD3](https://onco.cc/targets/pold3/), [POLD4](https://onco.cc/targets/pold4/), [POLE](https://onco.cc/targets/pole/), [POLE2](https://onco.cc/targets/pole2/), [POLE3](https://onco.cc/targets/pole3/), [POLQ](https://onco.cc/targets/polq/), [POT1](https://onco.cc/targets/pot1/), [PPM1D](https://onco.cc/targets/ppm1d/), [PRC1](https://onco.cc/targets/prc1/), [PRDM16](https://onco.cc/targets/prdm16/), [PREX2](https://onco.cc/targets/prex2/), [PRIM1](https://onco.cc/targets/prim1/), [PRIM2](https://onco.cc/targets/prim2/), [PSMD4](https://onco.cc/targets/psmd4/), [PTPN13](https://onco.cc/targets/ptpn13/), [PTPRB](https://onco.cc/targets/ptprb/), [PTPRC](https://onco.cc/targets/ptprc/), [PTPRD](https://onco.cc/targets/ptprd/), [PTPRK](https://onco.cc/targets/ptprk/), [PTPRT](https://onco.cc/targets/ptprt/), [QKI](https://onco.cc/targets/qki/), [RAD50](https://onco.cc/targets/rad50/), [RAD51](https://onco.cc/targets/rad51/), [RAD51B](https://onco.cc/targets/rad51b/), [RAD51C](https://onco.cc/targets/rad51c/), [RAD51D](https://onco.cc/targets/rad51d/), [RANBP2](https://onco.cc/targets/ranbp2/), [RAP1GDS1](https://onco.cc/targets/rap1gds1/), [RB1](https://onco.cc/targets/rb1/), [RECQL4](https://onco.cc/targets/recql4/), [RGS7](https://onco.cc/targets/rgs7/), [RHOH](https://onco.cc/targets/rhoh/), [RHPN2](https://onco.cc/targets/rhpn2/), [RICTOR](https://onco.cc/targets/rictor/), [RMI2](https://onco.cc/targets/rmi2/), [RRAS2](https://onco.cc/targets/rras2/), [RRM2](https://onco.cc/targets/rrm2/), [RRM2B](https://onco.cc/targets/rrm2b/), [RSF1](https://onco.cc/targets/rsf1/), [RSPO2](https://onco.cc/targets/rspo2/), [RSPO3](https://onco.cc/targets/rspo3/), [RUNX1](https://onco.cc/targets/runx1/), [RUNX1T1](https://onco.cc/targets/runx1t1/), [SDHB](https://onco.cc/targets/sdhb/), [SDHC](https://onco.cc/targets/sdhc/), [SETBP1](https://onco.cc/targets/setbp1/), [SETDB1](https://onco.cc/targets/setdb1/), [SF3B1](https://onco.cc/targets/sf3b1/), [SGK1](https://onco.cc/targets/sgk1/), [SMAD3](https://onco.cc/targets/smad3/), [SMAD4](https://onco.cc/targets/smad4/), [SMARCD1](https://onco.cc/targets/smarcd1/), [SND1](https://onco.cc/targets/snd1/), [SOS1](https://onco.cc/targets/sos1/), [SPEN](https://onco.cc/targets/spen/), [STAG2](https://onco.cc/targets/stag2/), [STARD3](https://onco.cc/targets/stard3/), [STK11](https://onco.cc/targets/stk11/), [SUZ12](https://onco.cc/targets/suz12/), [SYK](https://onco.cc/targets/syk/), [TBL1XR1](https://onco.cc/targets/tbl1xr1/), [TBX3](https://onco.cc/targets/tbx3/), [TCF7L2](https://onco.cc/targets/tcf7l2/), [TERT](https://onco.cc/targets/tert/), [TFEB](https://onco.cc/targets/tfeb/), [TFF3](https://onco.cc/targets/tff3/), [TGFBR2](https://onco.cc/targets/tgfbr2/), [TIMP1](https://onco.cc/targets/timp1/), [TLK2](https://onco.cc/targets/tlk2/), [TOP2B](https://onco.cc/targets/top2b/), [TOX3](https://onco.cc/targets/tox3/), [TP63](https://onco.cc/targets/tp63/), [TRIM24](https://onco.cc/targets/trim24/), [TRIM33](https://onco.cc/targets/trim33/), [TRPS1](https://onco.cc/targets/trps1/), [TSC1](https://onco.cc/targets/tsc1/), [TUBA1A](https://onco.cc/targets/tuba1a/), [TUBA1B](https://onco.cc/targets/tuba1b/), [TUBA1C](https://onco.cc/targets/tuba1c/), [TUBA3C](https://onco.cc/targets/tuba3c/), [TUBA3E](https://onco.cc/targets/tuba3e/), [TUBA4A](https://onco.cc/targets/tuba4a/), [TUBB1](https://onco.cc/targets/tubb1/), [TUBB2A](https://onco.cc/targets/tubb2a/), [TUBB2B](https://onco.cc/targets/tubb2b/), [TUBB3](https://onco.cc/targets/tubb3/), [TUBB4A](https://onco.cc/targets/tubb4a/), [TUBB4B](https://onco.cc/targets/tubb4b/), [TUBB6](https://onco.cc/targets/tubb6/), [TUBB8](https://onco.cc/targets/tubb8/), [UBR5](https://onco.cc/targets/ubr5/), [USP6](https://onco.cc/targets/usp6/), [USP8](https://onco.cc/targets/usp8/), [VHL](https://onco.cc/targets/vhl/), [WIF1](https://onco.cc/targets/wif1/), [WWTR1](https://onco.cc/targets/wwtr1/), [YAP1](https://onco.cc/targets/yap1/), [YES1](https://onco.cc/targets/yes1/), [ZBTB16](https://onco.cc/targets/zbtb16/), [ZFHX3](https://onco.cc/targets/zfhx3/), [ZFPM2](https://onco.cc/targets/zfpm2/), [ZMIZ1](https://onco.cc/targets/zmiz1/), [ZMYM3](https://onco.cc/targets/zmym3/), [ZNF217](https://onco.cc/targets/znf217/), [ZNF703](https://onco.cc/targets/znf703/), [ZXDB](https://onco.cc/targets/zxdb/) --- JSON: https://onco.cc/api/v1/entities/breast-cancer.json