Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment often promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Breast Cancer Working Group, recognising that they may not always be possible.

Timeframes for care

Step in pathway	Care point	Timeframe
Presentation, initial investigations and referral	Signs and symptoms	A patient with signs and symptoms that may suggest breast cancer should be seen by a GP within 2 weeks
	Initial investigations initiated by GP	Optimally, tests should be done within 2 weeks
	Referral to specialist	A positive result on any component of the triple test warrants specialist surgical referral. Ideally the surgeon should see the patient with proven or suspected cancer within 2 weeks of diagnosis. If necessary, prior discussion should facilitate referral
Diagnosis, staging and treatment planning	Diagnosis and staging	Diagnostic investigations should be completed within 2 weeks of the initial specialist consultation
Diagnosis, staging and treatment planning	Multidisciplinary meeting and treatment planning	Ideally, the multidisciplinary team should discuss all newly diagnosed patients with breast cancer prior to surgery or neoadjuvant chemotherapy Results of all relevant tests and imaging should be available for the MDM Referral to a breast cancer nurse within 7 days of definitive diagnosis
Treatment	Surgery	Surgery should occur ideally within 5 weeks of the decision to treat (for invasive breast cancer)
	Chemotherapy and Systemic therapy	Neoadjuvant chemotherapy should begin within 4 weeks of the decision to treat Adjuvant chemotherapy should begin within 6 weeks of surgery Adjuvant chemotherapy for triple-negative breast and HER2-positive breast cancer should begin within 4 weeks of surgery Endocrine therapy should begin as soon as appropriate after completing chemotherapy, radiation therapy and/or surgery (and in some cases will be started in the neoadjuvant setting)
	Radiation therapy	For patients who don’t have adjuvant chemotherapy, radiation therapy should begin within 8 weeks of surgery For patients who have adjuvant chemotherapy, radiation therapy should begin 3–4 weeks after chemotherapy

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral of patients with suspected breast cancer

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent, residual or metastatic disease

Step 7: End-of-life care

Breast cancer is the most common cancer in Australian women, accounting for more than 29 per cent of newly diagnosed cancers. It is second only to lung cancer as the most common cause of death from cancer (AIHW 2019).

Breast cancer in men accounts for less than 1 per cent of all breast cancers, with 90 per cent of men diagnosed with breast cancer after the age of 50 (Cancer Australia 2016). The recommendations in this document apply to all patients unless otherwise specified.

Early breast cancer may or may not have spread to lymph nodes in the armpit. Advanced breast cancer comprises both locally advanced breast and metastatic breast cancer (Cardoso et al. 2018). Locally advanced breast cancer is breast cancer with extensive axillary nodal involvement and that may have spread to areas near the breast, such as the chest wall.