This material contains practice management guidelines for the diagnosis, treatment, and follow-up of patients with breast cancer. These are the result of a lengthy, consensus-based process which has involved physicians, nurses, and patient care advocates who have commitment to the care of women whose lives may be affected by breast cancer. To the greatest degree possible the guidelines have been based on available scientific literature and the recommendations of national organizations dealing with this disease. However, in some cases such recommendations have been modified when experience at our institution has been able to improve or simplify them. While there may be occasions when exceptions need to be made for individual patients, these guidelines are intended to cover the majority of concerns and treatment options that will be encountered in the treatment of breast cancer.

The implementation of these guidelines has several goals, including the following.

1. To better inform physicians referring patients with breast cancer about the treatment options that will be discussed with their patients.
2. To standardize the care of breast patients by their treating physicians along "best practice" guidelines.

To render patient care more streamlined and less intrusive on the lives of our patients by adherence to these guidelines.

These guidelines should not be static or set in stone. Rather, our desire is to create a dynamic process that will revise or update these guidelines as our knowledge of breast cancer and its treatment progresses. Comments and constructive criticism of the material or requests for a complete Practice Management Guideline in printed form are invited by contacting 865.305.6921, toll-free at 1.866.337.8824, ext. 6921, or e-mail the UT Breast Care Service Coordinator Linda Cruze, R.N., so the medical community can be better served in subsequent iterations.

Index of Breast Care Service Physician Practice Management Guidelines follows.

• Patient Access or How To Refer A Patient
• Access Guideline for the Uninsured or Underinsured Population
• Breast Care Service Goals and Patient Expectations
• Patient Professional Team
• Breast Screening/Wellness Promotion
• Breast Cancer Risk Assessment
• Genetic Testing Criteria for Women
  • Without Breast Cancer
  • With Breast Cancer
• Breast Cancer Follow-Up Guideline
• Women's Health and Cancer Rights Act of 1998
• Breast Cancer Chemotherapy
  • Cytoxan
  • Methotrexate
  • 5FU
  • Adriamycin
  • Taxol
  • Taxotere
  • Herceptin
  • Aredia

UT Breast Care Service Guideline Committee

David B. Reath, MD, Associate Professor, Surgery Reconstructive (Committee Chairman)
John L. Bell, MD, Professor of Surgery, Surgical Oncology; Director, UT Cancer Institute
Susan P. Dodd, MD, Assistant Professor, OB/GYN
Daniel M. Green, MD, Medical Director, Radiation Oncology; Clinical Assoc Prof, Radiology
Renee Hawk, MPH, Administrative Director, UT Cancer Institute
Kathleen Hudson, MD, Associate Professor, Radiology; Director, University Breast Center
Linda Kirkland-Cruze, RN, BSN, CMC, Coordinator, UT Breast Care Service
Rebecca Libby, RN, BSN, Coordinator, Oncology Clinical Trials
Matthew Mancini, MD, Instructor, Surgery
Daphne Norwood, MD, Assistant Professor, Medicine
Timothy J. Panella, MD, Clinical Assistant Professor, Medical Oncology
Stuart Van Meter, MD, Associate Professor, Pathology

Contributors

American Joint Committee on Cancer (AJCC)
Dudrick, Paul S., MD, Assistant Professor, Surgery, Surgical Oncology
Hansard, Cindy, RN, OCN, Coordinator, Outpatient Chemotherapy
Huggler, Paige Z. BS, Community Health Educator, Breast Health Outreach
Littleton, Connie, Specialist, Preston Medical Library
Lozzio, Carmen B., MD, Genetics Director, Developmental and Genetic Center
McBrayer, Randi, RN, OCN, Nurse Specialist, Outpatient Chemotherapy
Prichard, Doris S., MSLS, Director, Preston Medical Library

For more information, please contact the Breast Care Service by calling 865.305.6921