Consensus and guideline comparisons
| Consensus/Guideline | YBCC3 | BCY520 | ESMO21 | NCCN22,23 | ASCO24,25 |
|---|---|---|---|---|---|
| Age definition | < 40 years | < 40 years | Not specified | Not specified | Not specified |
| BRCA1/2 testing criteria | Recommended for patients with a family history, TNBC, or age < 40 years | Follow national/international guidelines | / | Patients ≤ 50 years | Recommended for all newly diagnosed patients ≤ 65 years |
| Surgical approaches (patients with BRCA mutation) | 1. BCS based on individual risk | 1. Encourage BCS | 1. BCS with radiotherapy is a safe alternative to RRM for high-risk PV-associated patients | 1. BCS possible; discuss risk reduction | 1. BCS requires weighing risks and surveillance capabilities |
| 2. Contralateral mastectomy depends on age/family history | 2. Consider bilateral mastectomy | / | / | / | |
| 3. RRSO timing by mutation type/patient preference | 3. RRSO: | 3. RRSO: | 3. RRSO: | / | |
| BRCA1 (35–40 years) | BRCA1 (35–40 years) | BRCA1 (35–40 years) | |||
| BRCA2 (~40 years) | BRCA2 (~40 years) | BRCA2 (~40 years) | |||
| Chemotherapy | 1. Intensification of chemotherapy solely based on age is not recommended | 1. Intensification of chemotherapy solely based on age is not recommended | / | / | / |
| 2. Avoid platinum replacing anthracycline | 2. Anthracycline remains standard | / | / | / | |
| 3. No consensus on platinum for patients with BRCA mutation | 3. Consider platinum for patients with TNBC or BRCA mutation in neoadjuvant | / | / | / | |
| 4. Prefer liposomal doxorubicin because of less toxicity, such as cardiotoxicity and alopecia | / | / | / | / | |
| Endocrine therapy | 1. OFS + AI for high-risk patients | 1. OFS + AI for high-risk patients | / | 1. OFS + ET for premenopausal and high-risk patients | / |
| 2. 3M GnRHa or 1M GnRHa | 2. Prefer 1M GnRHa | / | 2. 3M GnRHa or 1M GnRHa | / | |
| 3. Estrogen monitoring debated | 3. Monitor estradiol if ovarian escape suspected | / | / | / | |
| Fertility preservation | 1. GnRHa during chemotherapy | 1. GnRHa during chemotherapy | / | 1. GnRHa during chemotherapy | 1. GnRHa (When proven fertility preservation methods are not feasible) |
| 2. Avoid cyclophosphamide during chemotherapy | / | / | / | ||
| 3. Using ART before treatment | 3. Using ART before treatment | 3. Patients should be advised not to become pregnant while on any systemic therapy | 3. Various ARTs are recommended | ||
| 4. Postpone pregnancy post-recurrence peak | 4. HR+ patients: complete 18–24 months of ET before pregnancy | / | / | / | |
| Gynecologic management | 1. Monitor endometrial thickness (tamoxifen users) | / | / | / | / |
| 2. Use barrier contraception and avoid hormonal methods | 2. Hormonal contraception contraindicated in young survivors | / | 2. Use IUD, barrier, tubal ligation, or vasectomy (patients with no intent of future pregnancies) for contraception and avoid hormonal methods | / |
AI, aromatase inhibitor; ART, assisted reproductive technology; BCS, breast-conserving surgery; GnRHa, gonadotropin-releasing hormone agonist; IUD, intrauterine device; OFS, ovarian function suppression; PV, pathogenic variant; RRM, risk-reducing mastectomy; RRSO, risk-reducing salpingo-oophorectomy; TNBC, triple-negative breast cancer.