Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

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Abstract
Breast cancer is the most common cancer in women in many countries, including developing countries. In 2006, the crude incidence in the European Union was 109.8/100 000, and the mortality was 38.4/100 000 women/year. In 2008, 1.38 million new cases and 458 000 breast cancer deaths were noted in the world. Since 1990 the incidence rate has increased 1.5% annually. Due to advances both in early detection and in adjuvant treatment, mortality rates from breast cancer have been decreasing steadily in most Western countries since the early 1990s. However, it is still the leading cause of cancer mortality in women. Approximately 4–6% of breast cancers are metastatic at diagnosis; of those approximately one-fifth will survive 5 years. Depending on prognostic factors, in the worst-case scenario, up to 30% of node-negative and up to 70% of node-positive breast cancers will relapse. The prevalence of metastatic disease is high because many women live with the disease for several years.

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