Patient handout

Breast cancer (core)

PRODUCTION

1. Your condition

This handout is for breast cancer (core). Your care team identified this based on: screen-detected or diagnostic mammographic abnormality bi-rads 4-5 (nccn breast 2026).

Other reasons your team may use this plan: palpable breast mass, nipple discharge (bloody/unilateral), or skin change (nccn breast 2026); biopsy-confirmed invasive breast cancer or dcis (nccn breast 2026); age 40-74 for biennial screening mammography (uspstf 2024 grade b).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
tamoxifen	20 mg	PO	once daily x 5-10 years	Premenopausal HR+ adjuvant standard; 10-year duration improves OS in higher-risk (ATLAS); also acceptable postmenopausal if AI intolerance
anastrozole	1 mg	PO	once daily x 5 years	Postmenopausal HR+ adjuvant first-line; superior to tamoxifen for DFS (ATAC); recommend bone-density surveillance
letrozole	2.5 mg	PO	once daily x 5 years	Alternative postmenopausal AI; equally efficacious to anastrozole (BIG 1-98)
exemestane	25 mg	PO	once daily	Steroidal AI option; switch strategy after 2-3 yr tamoxifen (TEAM)
abemaciclib	150 mg	PO	BID x 2 years	monarchE (Johnston JCO 2020 PMID 32954927) — 2-year adjuvant abemaciclib + ET improves iDFS in node-positive high-risk HR+/HER2- early breast cancer

Plan: HR+/HER2- adjuvant endocrine therapy ladder

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Erythema, peau d-orange, rapidly progressive skin change with biopsy showing dermal lymphatic invasion (T4d) — inflammatory breast cancer (IBC)
Bone metastases with new back pain + neurologic deficit (motor weakness, sensory level, bladder/bowel) — MRI within hours(life-threatening)
Corrected Ca >12 mg/dL with metastatic breast cancer — symptomatic (confusion, AKI, arrhythmia)
heart pumping strength (LVEF) drop >=10% to <50% on anti-HER2, or symptomatic HF
Grade >=3 immune-related toxicity on pembrolizumab (pneumonitis, hepatitis, colitis, myocarditis, endocrinopathy with hospitalization, severe skin)

5. Follow-up

NCCN survivorship intervals: H&P q3-6 mo x 5 yr then annual; annual mammogram; 5-10 yr endocrine therapy adherence; fertility preservation conversation if premenopausal at diagnosis; sexuality + lymphedema + psychosocial support; genetic counseling for cascade testing if BRCA+ (NCCN Breast 2026)

6. Sources

Guideline: NCCN Breast 2026 + St Gallen 2025 + USPSTF 2024 screening + ASCO 2022 metastatic + NCCN germline 2024