• Vol. 44 No. 10, 368–378
  • 15 October 2015

Singapore Cancer Network (SCAN) Guidelines for Bisphosphonate Use in the Adjuvant Breast Cancer Setting



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Introduction: The SCAN breast cancer workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines regarding the optimal time-point for initiation of bisphosphonates when using adjuvant aromatase inhibitors (AIs) and provide a consensus for their role in modifying clinical breast cancer outcomes

Materials and Methods: The workgroup utilised a modified ADAPTE process to calibrate high quality international evidence-based clinical practice guidelines to our local setting.

Results: : Six international guidelines were evaluated—those developed by the National Cancer Comprehensive Network (2015), the European Society of Medical Oncology (2014), the National Institute for Clinical Evidence (2012), the Scottish Intercollegiate Guidelines Network (2013), the British Columbia Cancer Agency (2013) and the treatment algorithm based on the National Osteoporosis Foundation guidelines (2006). Recommendations on the use of bisphosphonates in postmenopausal women initiating adjuvant AIs in breast cancer to preserve bone health and the use of adjuvant bisphosphonates to improve breast cancer outcomes were developed.

Conclusion: These adapted guidelines form the SCAN Guidelines on the use of adjuvant bisphosphonates to influence breast cancer outcomes and maintenance of bone health when on AIs.

Breast cancer is the leading female cancer in our multiethnic Singaporean population and the most frequent cause of cancer mortality in females. The age-standardised incidence rate of newly diagnosed breast cancers in females has increased almost 3-fold in the last 4 decades from 23.8 per 100,000 in 1975 to 1979 to 64.7 per 100,000 in 2010 to 2014. With our rapidly aging population demographics, the percentage of total breast cancers in women aged 55 years and above has correspondingly increased from 43.4% in 2004 to 2008 to 51.3% in 2009 to 2013. Fortunately, due to improved education, increased public awareness and the implementation of our national screening programme, the majority of breast cancers are now being diagnosed earlier. Hormone receptor-positive breast cancers comprise the most common breast cancer subtypes, accounting for 75% of the cases.

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