The clinical database and implementation of treatment guidelines by the Danish Breast Cancer Cooperative Group in 2007–2016

Figures & data

Figure 1. Panel A: Distribution in percent of use of ALND according to year of surgery for patients with invasive breast cancer with micrometastases only in SN (N = 4869 for the period 2007–2016). Panel B: Distribution in percent of HER2 status according to year of surgery for patients with ER positive disease 60 years or older at diagnosis (N = 22,209).

Table 1. Changes 2007–2016 in guidelines selected for data presentation.

Treatments	Specification of guideline changes	Introduction
ALND following SN	Omitted in case of micrometastases only	Dec 2011
HER2	Implementation of national guidelines for standardization and interpretation of HER2 staining procedures according to ASCO CAP with modifications in 2013	Sep 2008Feb 2014
	Trastuzumab if HER2 positive and HR− or HR+ and <60 years	Jan 2007
	Trastuzumab if HER2 positive irrespective of other risk factors	Apr 2010
Fractionation	48 Gy/24 Fr changed to 50 Gy/25 Fr	Jan 2009
	BCS, breast only RT, no boost (two centers): 40 Gy/15 Fr	Feb 2010
	BCS, breast only RT, >40 years: 40 Gy/15 Fr	Apr 2014
	BCS, breast only RT: 40 Gy/15 Fr	2014–2016
Target volume	Loco-regional RT: IMN included left sided also	Jun 2014
Endocrine treatment	Upfront letrozole to postmenopausal patients	Jan 2009
Chemotherapy	Inclusion of taxanes (sequential EC followed by a taxane)	Jan 2007

ALND: axillary lymph node dissection; SN: sentinel node; IHC: Immunohistochemistry; ISH: In situ hybridization; HER2: human epidermal growth factor receptor 2; HR: hormone receptor; Fr: fractions; BCS: breast conserving surgery; RT: radiation therapy; IMN: internal mammary nodes.

Figure 2. Panel A: Distribution in percent of fractionation used for invasive breast cancer patients with breast only radiation therapy according to year of radiation (N = 15,005; patients in RT trials not included). Panel B: Distribution in percent of inclusion of IMN (internal mammary nodes) according to year of radiation for patients with loco-regional radiotherapy and left-sided breast cancer (N = 5805). Panel C: Distribution in percent of up-front treatment with either tamoxifen (TAM) or an aromatase inhibitor (AI) according to year of inclusion for postmenopausal patients allocated to endocrine treatment (N = 17,314; patients in trials for systemic treatment not included). Panel D: Distribution in percent of high-risk patients allocated to chemotherapy according to year of inclusion and whether chemotherapy was taxane based (N = 14,457).