National care program for breast cancer updated in Sweden

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.

See the more details in Swedish here, and the full text of the care program here

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