Interpretation of the 2024 ESMO clinical practice guideline for the diagnosis, treatment, and follow-up of early breast cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Tianyuan ^1,2 , ZHU Zhongjian ^1,2 ,  DU Zhenggui ^1,2

1. Department of General Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;
2. Breast Center, West China Hospital of Sichuan University, Chengdu, China, 610041, P. R. China;

Corresponding author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

Early breast cancer; TNM staging; multidisciplinary therapy; survivorship care; ESMO guidelines

DOI：

10.7507/1007-4848.202504014

Video：

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[Abstract] Breast cancer is one of the most common malignant tumors in women, and its treatment and management strategies are crucial for improving patients’ prognosis and quality of life. Early breast cancer refers to lesions confined to the breast and regional lymph nodes (N1 stage) without distant metastasis. Thanks to the improvement of screening techniques, the detection rate of early breast cancer has increased. The "early diagnosis and early treatment" model has led to a decrease in breast cancer mortality, especially among young women. The 2024 European Society for Medical Oncology (ESMO) clinical practice guideline for the diagnosis, treatment, and follow-up of early breast cancer aims to provide comprehensive and standardized recommendations for the diagnosis and treatment of early breast cancer, helping clinicians make optimal decisions. This article interprets the main content of the guideline in order to provide references and assistance for the current clinical diagnosis and treatment of early breast cancer in China.

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin, 2021, 71(3): 209-249.
2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin, 2024, 74(3): 229-263.
3.	黎星, 彭子琪, 于鑫淼, 等. 2024年改变早期乳腺癌临床实践的重要研究成果及进展. 中国癌症杂志, 2025, 35(2): 176-85.Li X, Peng ZQ, Yu XM, et al. Important research progress in clinical practice for early breast cancer in 2024. Chin J Cancer, 2025, 35(2): 176-85.
4.	李俊杰. 早期乳腺癌局部治疗与全身治疗的进展与展望. 中国癌症杂志, 2025, 35(2): 205-212.Li JJ. Progress and future prospects in local and systemic treatment of early breast cancer. Chinese Journal of Cancer, 2025, 35(2): 205-212.
5.	中国抗癌协会乳腺癌专业委员会, 中华医学会肿瘤学分会乳腺肿瘤学组. 中国抗癌协会乳腺癌诊治指南与规范(2024年版). 中国癌症杂志, 2023, 33(12): 1092-1187.Chinese Society of Clinical Oncology, Breast Cancer Professional Committee of Chinese Anti-Cancer Association, Breast Tumor Group of Chinese Medical Association. Guidelines and standards for the diagnosis and treatment of breast cancer by Chinese Anti-cancer Association (2024 edition). Chin J Cancer, 2023, 33(12): 1092-1187.
6.	张正, 张莉芳, 刘彦廷, 等. 《2022全球癌症统计报告》解读. 中国医院统计, 2024, 31(5): 393-400.
7.	Zhang Z, Zhang LF, Liu YT, et al. Interpretation of the “Global Cancer Statistics 2022 Report. ” Chin J Hospital Statistics, 2024, 31(5): 393-400. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
8.	Autier P, Boniol M, La Vecchia C, et al. Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ, 2010, 341: c3620.
9.	Winters S, Martin C, Murphy D, Shokar NK. Breast cancer epidemiology, prevention, and screening. Prog Mol Biol Transl Sci, 2017, 151: 1-32.
10.	Schunemann HJ, Lerda D, Quinn C, et al. Breast cancer screening and diagnosis: A synopsis of the European breast guidelines. Ann Intern Med, 2020, 172(1): 46-56.
11.	Marmot MG, Altman DG, Cameron DA, et al. The benefits and harms of breast cancer screening: An independent review. Br J Cancer, 2013, 108(11): 2205-2240.
12.	Duffy S, Vulkan D, Cuckle H, et al. Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: Long-term follow-up of the UK Age RCT. Health Technol Assess, 2020, 24(55): 1-24.
13.	Duffy SW, Tabar L, Yen AM, et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549, 091 women. Cancer, 2020, 126(13): 2971-2979.
14.	Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI screening for women with extremely dense breast tissue. N Engl J Med, 2019, 381(22): 2091-2102.
15.	Comstock CE, Gatsonis C, Newstead GM, et al. Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening. JAMA, 2020, 323(8): 746-756.
16.	Veenhuizen S, de Lange SV, Bakker MF, et al. Supplemental breast MRI for women with extremely dense breasts: Results of the second screening round of the DENSE trial. Radiology, 2021, 299(2): 278-286.
17.	Aznar MC, Meattini I, Poortmans P, et al. "To clip or not to clip. That is no question!". Eur J Surg Oncol, 2017, 43(7): 1145-1147.
18.	Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: Safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad395.
19.	Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: Medium-term oncological safety outcomes and feasibility of 24 h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
20.	Kim JH, Ryu JM, Bae SJ, et al. Minimal access vs conventional nipple-sparing mastectomy. JAMA Surg, 2024, 159(6): 688-690.
21.	Cardoso MJ, Wyld L, Rubio IT, et al. EUSOMA position regarding breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use of textured implants. Breast, 2019, 44: 90-93.
22.	Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: Overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol, 2010, 11(10): 927-933.
23.	Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: A randomized clinical trial. JAMA, 2011, 305(6): 569-575.
24.	Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA, 2017, 318(10): 918-926.
25.	Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): A phase 3 randomised controlled trial. Lancet Oncol, 2013, 14(4): 297-305.
26.	Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol, 2018, 19(10): 1385-1393.
27.	Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol, 2014, 15(12): 1303-1310.
28.	Park KU, Somerfield MR, Anne N, et al. Sentinel lymph node biopsy in early-stage breast cancer: ASCO guideline update. J Clin Oncol, 2025, 43(14): 1720-1741.
29.	Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10, 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
30.	Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol, 2015, 16(1): 47-56.
31.	Coles CE, Griffin CL, Kirby AM, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet, 2017, 390(10099): 1048-1060.
32.	Wu ZY, Han J, Kim HJ, et al. Breast cancer outcomes following immediate breast reconstruction with implants versus autologous flaps: A propensity score-matched study. Breast Cancer Res Treat, 2022, 191(2): 365-373.
33.	Geyer CJ, Garber JE, Gelber RD, et al. Overall survival in the OlympiA phase Ⅲ trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer. Ann Oncol, 2022, 33(12): 1250-1268.
34.	Untch M, Jackisch C, Schneeweiss A, et al. NAB-paclitaxel improves disease-free survival in early breast cancer: GBG 69-GeparSepto. J Clin Oncol, 2019, 37(25): 2226-2234.
35.	Praga C, Bergh J, Bliss J, et al. Risk of acute myeloid leukemia and myelodysplastic syndrome in trials of adjuvant epirubicin for early breast cancer: Correlation with doses of epirubicin and cyclophosphamide. J Clin Oncol, 2005, 23(18): 4179-4191.
36.	Romond EH, Jeong JH, Rastogi P, et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol, 2012, 30(31): 3792-3799.
37.	van der Voort A, van Ramshorst MS, van Werkhoven ED, et al. Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual ERBB2 blockade in patients with ERBB2-positive breast cancer: A secondary analysis of the TRAIN-2 randomized, phase 3 trial. JAMA Oncol, 2021, 7(7): 978-984.
38.	Gianni L, Pienkowski T, Im YH, et al. 5-year analysis of neoadjuvant pertuzumab and trastuzumab in patients with locally advanced, inflammatory, or early-stage HER2-positive breast cancer (NeoSphere): a multicentre, open-label, phase 2 randomised trial. Lancet Oncol, 2016, 17(6): 791-800.
39.	von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med, 2019, 380(7): 617-628.
40.	Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med, 2017, 376(22): 2147-2159.
41.	van Mackelenbergh MT, Seither F, Mobus V, et al. Effects of capecitabine as part of neo-/adjuvant chemotherapy – A meta-analysis of individual breast cancer patient data from 13 randomised trials including 15, 993 patients. Eur J Cancer, 2022, 166: 185-201.
42.	Lai LM, Gropman AL, Whitehead MT. MR neuroimaging in pediatric inborn errors of metabolism. Diagnostics (Basel), 2022, 12(4): 801.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin, 2021, 71(3): 209-249.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin, 2024, 74(3): 229-263.
3. 黎星, 彭子琪, 于鑫淼, 等. 2024年改变早期乳腺癌临床实践的重要研究成果及进展. 中国癌症杂志, 2025, 35(2): 176-85.Li X, Peng ZQ, Yu XM, et al. Important research progress in clinical practice for early breast cancer in 2024. Chin J Cancer, 2025, 35(2): 176-85.
4. 李俊杰. 早期乳腺癌局部治疗与全身治疗的进展与展望. 中国癌症杂志, 2025, 35(2): 205-212.Li JJ. Progress and future prospects in local and systemic treatment of early breast cancer. Chinese Journal of Cancer, 2025, 35(2): 205-212.
5. 中国抗癌协会乳腺癌专业委员会, 中华医学会肿瘤学分会乳腺肿瘤学组. 中国抗癌协会乳腺癌诊治指南与规范(2024年版). 中国癌症杂志, 2023, 33(12): 1092-1187.Chinese Society of Clinical Oncology, Breast Cancer Professional Committee of Chinese Anti-Cancer Association, Breast Tumor Group of Chinese Medical Association. Guidelines and standards for the diagnosis and treatment of breast cancer by Chinese Anti-cancer Association (2024 edition). Chin J Cancer, 2023, 33(12): 1092-1187.
6. 张正, 张莉芳, 刘彦廷, 等. 《2022全球癌症统计报告》解读. 中国医院统计, 2024, 31(5): 393-400.
7. Zhang Z, Zhang LF, Liu YT, et al. Interpretation of the “Global Cancer Statistics 2022 Report. ” Chin J Hospital Statistics, 2024, 31(5): 393-400. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
8. Autier P, Boniol M, La Vecchia C, et al. Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ, 2010, 341: c3620.
9. Winters S, Martin C, Murphy D, Shokar NK. Breast cancer epidemiology, prevention, and screening. Prog Mol Biol Transl Sci, 2017, 151: 1-32.
10. Schunemann HJ, Lerda D, Quinn C, et al. Breast cancer screening and diagnosis: A synopsis of the European breast guidelines. Ann Intern Med, 2020, 172(1): 46-56.
11. Marmot MG, Altman DG, Cameron DA, et al. The benefits and harms of breast cancer screening: An independent review. Br J Cancer, 2013, 108(11): 2205-2240.
12. Duffy S, Vulkan D, Cuckle H, et al. Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: Long-term follow-up of the UK Age RCT. Health Technol Assess, 2020, 24(55): 1-24.
13. Duffy SW, Tabar L, Yen AM, et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549, 091 women. Cancer, 2020, 126(13): 2971-2979.
14. Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI screening for women with extremely dense breast tissue. N Engl J Med, 2019, 381(22): 2091-2102.
15. Comstock CE, Gatsonis C, Newstead GM, et al. Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening. JAMA, 2020, 323(8): 746-756.
16. Veenhuizen S, de Lange SV, Bakker MF, et al. Supplemental breast MRI for women with extremely dense breasts: Results of the second screening round of the DENSE trial. Radiology, 2021, 299(2): 278-286.
17. Aznar MC, Meattini I, Poortmans P, et al. "To clip or not to clip. That is no question!". Eur J Surg Oncol, 2017, 43(7): 1145-1147.
18. Feng Y, Xie Y, Liang F, et al. Twenty-four-hour discharge of patients after endoscopic nipple-sparing mastectomy and direct-to-implant breast reconstruction: Safety and aesthetic outcomes from a prospective cohort study. Br J Surg, 2024, 111(1): znad395.
19. Zhou J, Xie Y, Liang F, et al. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: Medium-term oncological safety outcomes and feasibility of 24 h discharge for breast cancer patients. Int J Surg, 2024, 110(4): 2243-2252.
20. Kim JH, Ryu JM, Bae SJ, et al. Minimal access vs conventional nipple-sparing mastectomy. JAMA Surg, 2024, 159(6): 688-690.
21. Cardoso MJ, Wyld L, Rubio IT, et al. EUSOMA position regarding breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and the use of textured implants. Breast, 2019, 44: 90-93.
22. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: Overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol, 2010, 11(10): 927-933.
23. Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: A randomized clinical trial. JAMA, 2011, 305(6): 569-575.
24. Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA, 2017, 318(10): 918-926.
25. Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): A phase 3 randomised controlled trial. Lancet Oncol, 2013, 14(4): 297-305.
26. Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol, 2018, 19(10): 1385-1393.
27. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol, 2014, 15(12): 1303-1310.
28. Park KU, Somerfield MR, Anne N, et al. Sentinel lymph node biopsy in early-stage breast cancer: ASCO guideline update. J Clin Oncol, 2025, 43(14): 1720-1741.
29. Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10, 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
30. Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol, 2015, 16(1): 47-56.
31. Coles CE, Griffin CL, Kirby AM, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet, 2017, 390(10099): 1048-1060.
32. Wu ZY, Han J, Kim HJ, et al. Breast cancer outcomes following immediate breast reconstruction with implants versus autologous flaps: A propensity score-matched study. Breast Cancer Res Treat, 2022, 191(2): 365-373.
33. Geyer CJ, Garber JE, Gelber RD, et al. Overall survival in the OlympiA phase Ⅲ trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer. Ann Oncol, 2022, 33(12): 1250-1268.
34. Untch M, Jackisch C, Schneeweiss A, et al. NAB-paclitaxel improves disease-free survival in early breast cancer: GBG 69-GeparSepto. J Clin Oncol, 2019, 37(25): 2226-2234.
35. Praga C, Bergh J, Bliss J, et al. Risk of acute myeloid leukemia and myelodysplastic syndrome in trials of adjuvant epirubicin for early breast cancer: Correlation with doses of epirubicin and cyclophosphamide. J Clin Oncol, 2005, 23(18): 4179-4191.
36. Romond EH, Jeong JH, Rastogi P, et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol, 2012, 30(31): 3792-3799.
37. van der Voort A, van Ramshorst MS, van Werkhoven ED, et al. Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual ERBB2 blockade in patients with ERBB2-positive breast cancer: A secondary analysis of the TRAIN-2 randomized, phase 3 trial. JAMA Oncol, 2021, 7(7): 978-984.
38. Gianni L, Pienkowski T, Im YH, et al. 5-year analysis of neoadjuvant pertuzumab and trastuzumab in patients with locally advanced, inflammatory, or early-stage HER2-positive breast cancer (NeoSphere): a multicentre, open-label, phase 2 randomised trial. Lancet Oncol, 2016, 17(6): 791-800.
39. von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med, 2019, 380(7): 617-628.
40. Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med, 2017, 376(22): 2147-2159.
41. van Mackelenbergh MT, Seither F, Mobus V, et al. Effects of capecitabine as part of neo-/adjuvant chemotherapy – A meta-analysis of individual breast cancer patient data from 13 randomised trials including 15, 993 patients. Eur J Cancer, 2022, 166: 185-201.
42. Lai LM, Gropman AL, Whitehead MT. MR neuroimaging in pediatric inborn errors of metabolism. Diagnostics (Basel), 2022, 12(4): 801.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesInterpretation of the 2024 ESMO clinical practice guideline for the diagnosis, treatment, and follow-up of early breast cancer

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