Contents

1. Screening

1.1 Recommendations for women at normal risk

1.1.1 Age 2039 years old

1.1.2 Age 4069 years old

1.1.3 Age 70 years old

1.2 Recommendations for women at increased risk

2. Diagnosis

2.1 Clinical manifestations

2.1.1 Breast lump

2.1.2 Nipple discharge

2.1.3 Skin changes

2.1.4 Abnormalities in nipple and areolar area

2.1.5 Enlarged axillary lymph nodes

2.2 Breast palpation

2.3 Imaging tests

2.3.1 Mammography

2.3.2 Breast ultrasound

2.3.3 Breast MRI

2.3.4 Positron emission tomography-computed tomography(PET-CT)

2.3.5 Bone scan

2.4 Laboratory tests

2.4.1 Blood chemistry: no significant changes in early-stagediseases

2.4.2 Tumor markers

3. Pathological assessments

3.1 Specimen type and fixation

3.1.1 Specimen type

3.1.2 Specimen fixation

3.2 Dissection and gross description

3.3 Classification, grading and staging

3.3.1 Histological classification

3.3.2 Histological grading

3.3.3 Staging

3.3.4 Immunohistochemistry, molecular pathology tests and quality control

3.3.5 Standardized pathology report

4. Differential diagnosis

5. Treatment

5.1 Principles

5.1.1 Non-invasive breast cancer

5.1.2 Invasive breast cancer

5.2 Surgical treatment

5.2.1 Principles

5.2.2 Breast surgery

5.2.3 Surgery for axillary lymph nodes

5.2.4 Oncoplastic and reconstructive surgery

5.3 Radiation therapy

5.3.1 Radiation therapy for early-stage breast cancer after BCS

5.3.2 Radiation therapy after modified radical mastectomy

5.3.3 Radiotherapy under special circumstances

5.4 Chemotherapy

5.4.1 Adjuvant chemotherapy

5.4.2 Neoadjuvant chemotherapy

5.4.3 Chemotherapy for late-stage breast cancer

5.5 Endocrine therapy

5.5.1 Adjuvant endocrine therapy

5.5.2 Endocrine therapy for late-stage breast cancer

5.6 HER-2 targeted therapy

5.6.1 Definition of HER-2 positivity

5.6.2 Special considerations

5.6.3 Adjuvant HER-2 targeted therapy

5.6.4 Neoadjuvant HER-2 targeted therapy

5.6.5 HER-2 targeted therapy for late-stage HER-2 positive breast cancer

6. Flowchart of diagnosis and treatment

7. Follow-up

7.1 Physical examination

7.2 Breast ultrasonography

7.3 Mammogram

7.4 Chest imaging

7.5 Abdominal ultrasonography

7.6 Bone scan

7.7 Blood tests and tumor markers

7.8 Annual pelvic examination

Breast cancer is the most common malignancy in women and is a major threat to women’s health. Currently, with comprehensive treatment modalities, the outcomes of breast cancer are among the best of solid tumors. A set of Chinese guidelines and recommendations are developed to standardize the clinical practice, to ensure the quality and safety of medical service, and to ultimately improve the survival of breast cancer patients.

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