This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of these guidelines, taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols. This guide has been compiled by a multidisciplinary group of healthcare professionals from a variety of settings who are involved in the care of people with breast cancer.  The content has been developed from commonly occurring queries from patients and the professionals who treat them.  It is not comprehensive, and does not replace the need for specialist advice where indicated; but intended to support the provision of consistent advice, shared decision making and signposting.

Pharmacological considerations

Some of the medicines advice within this guide falls outside a marketing authorisation:

• ‘Unlicensed medicine’ is used to describe medicines which have no licence for use in the UK.
• ‘Off-label’ medicines are ones that are licensed but are being used outside the terms of their UK licence.

Where referred to, these drugs will be identified with the symbol^†. Prescribers must be aware and follow relevant professional guidance, taking full responsibility for the decision, when prescribing outside the UK marketing authorisation.  In some areas, these drugs or indications will be non-formulary in which case local guidance and processes should be followed.