Background: In 2000 the first national evidence based guideline on screening and diagnostics for breast cancer was released. Two years later, in 2002, the first national multidisciplinary guideline for treatment followed. In 2008 these two guidelines were merged and revised in 2012, resulting in one national guideline for breast cancer which is widely accessible in the online guideline database Oncoline (www.oncoline.nl).
Materials and Methods: Due to new developments and insights, we executed a modular revision process in four parts. The revision was carried out by a working group consisting of mandated representatives from several scientific and professional associations, the Dutch Breast Cancer Organization (NABON) and the Breast Cancer Patient Association.
Results: In contrary to previous revisions performed each five years, the new modular revisions are characterized by a solid interaction with clinical practitioners supplemented with insight in new developments and up to date evidence leading to a more up to date guideline. The following topics were revised in the breast cancer guideline using the modular revision process:
Individualized diagnostics, treatment, follow up and aftercare.
Screening advices for new mutations of breast tumors (such as CHEK2 and PALB2).
Imaging for screening, diagnostics, staging and response monitoring, also for pregnant women.
Treatment options for DCIS and low risk invasive carcinoma, including no treatment or less treatment.
Locoregional treatment in multiple phases of the treatment.
Gene expression testing.
Indication for systemic treatment (specific for N0-tumours).
Available drugs for systemic treatment (neo adjuvant and adjuvant treatment, metastatic settings).
Inclusion of prediction models in the guideline.
Preventive removal of ovaries as a part of endocrine treatment.
Systemic treatment after recurrence.
Sexual problems and fatigue.
Impact of cancer on family life.
Breast cancer in men, pregnancy and fertility.
Further, throughout the whole guideline more focus on shared decision making was realized.
Conclusion: The new developments in breast cancer treatment are going fast. Therefore, the working group will continue making modular revisions of the multidisciplinary guideline for breast cancer patients as an ongoing process involving mandated representatives from several scientific and professional associations, NABON and patient representatives. Parallel and based on guidelines, we developed digital decision trees (www.oncoguide. nl), leading to recommendations for diagnosis and treatment based on individual patient and disease characteristics. We hope that the guideline improves the care for over 17000 newly diagnosed breast cancer patients.