# Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019.

**Organizacion:** St-Gallen
**Autores:** Burstein HJ, Curigliano G, Loibl S et al.
**Revista:** Ann Oncol (2019)
**PMID:** 31373601 | **PMCID:** -
**DOI:** [10.1093/annonc/mdz235](https://doi.org/10.1093/annonc/mdz235)
**Fuente:** PubMed (abstract only)

## Relevancia
Conferencia internacional de consenso bianual; punto de referencia mundial para la toma de decisiones en cancer de mama temprano. El panel multidisciplinar vota sobre escenarios clinicos clave, incluyendo des-escalada quirurgica axilar post-NAC en pacientes cN+ que convierten a ypN0.

## Recomendaciones clave (resumen)
- Acepta BSGC post-NAC en pacientes cN+ que convierten a cN0 si se cumplen estandares de calidad (>=3 ganglios, doble trazador, marcaje del ganglio biopsiado).
- Tendencia consistente a des-escalada quirurgica axilar en respondedoras.
- Recomienda evaluacion clinica/ecografica axilar post-NAC antes de la cirugia.
- TAD (Targeted Axillary Dissection) reconocida como tecnica aceptable para reducir tasa de falsos negativos.

## Abstract
The 16th St. Gallen International Breast Cancer Conference 2019 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer.

Treatments were assessed in light of their intensity, duration and side-effects, estimating the magnitude of clinical benefit according to stage and biology of the disease. The Panel acknowledged that for many patients, the impact of adjuvant therapy or the adherence to specific guidelines may have modest impact on the risk of breast cancer recurrence or overall survival. For that reason, the Panel explicitly encouraged clinicians and patients to routinely discuss the magnitude of benefit for interventions as part of the development of the treatment plan.

The guidelines focus on common ductal and lobular breast cancer histologies arising in generally healthy women. Special breast cancer histologies may need different considerations, as do individual patients with other substantial health considerations. The panelists' opinions reflect different interpretation of available data and expert opinion where is lack of evidence and sociocultural factors in their environment such as availability of and access to medical service, economic resources and reimbursement issues. Panelists encourage patient participation in well-designed clinical studies whenever available.

With these caveats in mind, the St. Gallen Consensus Conference seeks to provide guidance to clinicians on appropriate treatments for early-stage breast cancer and guidance for weighing the realistic tradeoffs between treatment and toxicity so that patients and clinical teams can make well-informed decisions on the basis of an honest reckoning of the magnitude of clinical benefit.

## Acceso
Via [DOI](https://doi.org/10.1093/annonc/mdz235) o suscripcion institucional.

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*Datos de PubMed. Citar: doi 10.1093/annonc/mdz235*
