On May 31, 2022, Regional Cancer Centers collaboration (RCC) updated the national care program for breast cancer. The following key changes are presented below:
- Everyone with triple-negative breast cancer (TNBC), regardless of age, should be offered genetic testing. Three new genes (BARD1, RAD51C, and RAD51D) have been proposed;
- Patients with triple-negative and HER2-positive breast cancer should always be recommended preoperative treatment and not offered primary surgery
- For patients who have 1-2 positive sentinel node glands at a "clinically negative axilla", the care program recommends primary radiotherapy instead of conventional axillary evacuation to reduce the risk of late complications;
- The care program recommends radiotherapy with only five daily fractions instead of the previous standard for primary breast cancer localized to the breast tissue;
- Indications for the use of gene expression analysis for luminal breast cancer have been clarified;
- Prior to treatment choice, the care program recommends performing both PD-L1 assays that are predictive of atezolizumab (PD-L1 assay on immune cells) and pembrolizumab (combined positive score), respectively;
- Mapping of the PIK3CA gene is recommended in patients with luminal breast cancer;
- A new separate chapter on breast cancer in men has been included in the care program.
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