Early and locally advanced breast cancer: diagnosis and management

Transcription

1 National Institute for Health and Care Excellence Draft Early and locally advanced breast cancer: diagnosis and management Search strategies NICE guideline tbc Search strategies November 2017 Draft for Consultation Evidence reviews were developed by National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists

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3 Error! No text of specified style in document. Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright National Institute for Health and Care Excellence, All rights reserved. Subject to Notice of Rights. ISBN:

4 Contents Contents Appendix F: Clinical evidence search strategies... 7 F.1 Surgical margins... 7 F.1.1 Database: Medline & Embase (Multifile)... 7 F.1.2 Database: Cochrane Library via Wiley Online... 9 F.2 Axillary treatment F.2.1 Database: Medline F.2.2 Database: Embase F.2.3 Database: Cochrane Library via Wiley Online F.3 Lymphoedema prevention F.3.1 Database: Medline & Embase (Multifile) F.3.2 Database: Cochrane Library via Wiley Online F.3.3 Database: Cinahl Plus F.3.4 Database: AMED F.3.5 Database: PsycINFO F.4 Progesterone receptor testing F.4.1 Database: Medline & Embase (Multifile) F.4.2 Database: Cochrane Library via Wiley Online F.5 Prognostic tools F.5.1 Database: Medline & Embase (Multifile) F.5.2 Database: Cochrane Library via Wiley Online F.6 Duration of endocrine therapy F.6.1 Database: Medline F.6.2 Database: Embase F.6.3 Database: Cochrane Library via Wiley Online F.7 Ovarian suppression F.7.1 Database: Medline F.7.2 Database: Embase F.7.3 Database: Cochrane Library via Wiley Online F.8 Chemoprevention F.8.1 Database: Medline & Embase (Multifile) F.8.2 Database: Cochrane Library via Wiley Online F.9 Taxanes F.9.1 Database: Medline & Embase (Multifile) F.9.2 Database: Cochrane Library via Wiley Online F.10 Trastuzumab F.10.1 Database: Medline & Embase (Multifile) F.10.2 Database: Cochrane Library via Wiley Online

5 Contents F.11 Bisphosphonates F.11.1 Database: Medline & Embase (Multifile) F.11.2 Database: Cochrane Library via Wiley Online F.12 Heart sparing radiotherapy F.12.1 Database: Medline & Embase (Multifile) F.12.2 Database: Cochrane Library via Wiley Online F.13 Breast radiotherapy after breast-conserving surgery F.13.1 Database: Medline F.13.2 Database: Embase F.13.3 Database: Cochrane Library via Wiley Online F.14 Partial breast radiotherapy F.14.1 Database: Medline & Embase (Multifile) F.14.2 Database: Cochrane Library via Wiley Online F.15 Radiotherapy to the internal mammary nodes F.15.1 Database: Medline F.15.2 Database: Embase F.15.3 Database: Cochrane Library via Wiley Online F.16 Post-mastectomy radiotherapy F.16.1 Database: Medline & Embase (Multifile) F.16.2 Database: Cochrane Library via Wiley Online F.17 Immediate versus delayed reconstruction F.17.1 Database: Medline & Embase (Multifile) F.17.2 Database: Cochrane Library via Wiley Online F.18 Neoadjuvant chemotherapy F.18.1 Database: Medline & Embase (Multifile) F.18.2 Database: Cochrane Library via Wiley Online F.19 Neoadjuvant endocrine therapy F.19.1 Database: Medline & Embase (Multifile) F.19.2 Database: Cochrane Library via Wiley Online F.20 Post neoadjuvant chemotherapy post-mastectomy radiotherapy F.20.1 Database: Medline & Embase (Multifile) F.20.2 Database: Cochrane Library via Wiley Online F.21 Platinum chemotherapy F.21.1 Database: Medline & Embase (Multifile) F.21.2 Database: Cochrane Library via Wiley Online F.22 Lifestyle F.22.1 Database: Medline & Embase (Multifile) F.22.2 Database: Cochrane Library via Wiley Online Appendix G: Health economics global search G.1 Database: Medline

6 Contents G.2 Database: Health Technology Assessment G.3 Database: NHS Economic Evaluation Database G.4 Database: Embase

7 Appendix F: Clinical evidence search strategies F.1 Surgical margins Review question: Do tumour-free tissue margins wider than 0mm reduce local recurrence for people with invasive breast cancer and/or ductal carcinoma in situ (DCIS) treated with breast conserving surgery? F.1.1 Database: Medline & Embase (Multifile) Last searched on Embase 1974 to 2017 January 29, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present.Date of last search: 30 January exp breast cancer/ use oemezd 2 exp breast carcinoma/ use oemezd 3 exp medullary carcinoma/ use oemezd 4 exp intraductal carcinoma/ use oemezd 5 exp breast tumor/ use oemezd 6 exp Breast Neoplasms/ use prmz 7 exp "Neoplasms, Ductal, Lobular, and Medullary"/ use prmz 8 Carcinoma, Intraductal, Noninfiltrating/ use prmz 9 Carcinoma, Lobular/ use prmz 10 Carcinoma, Medullary/ use prmz 11 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or exp breast/ use oemezd 13 exp Breast/ use prmz 14 breast.tw or 13 or (breast adj milk).tw. 17 (breast adj tender$).tw or not exp neoplasm/ use oemezd 21 exp Neoplasms/ use prmz or and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. use oemezd 25 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. use oemezd 26 (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. use prmz 7

8 27 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. use prmz 28 exp Paget nipple disease/ use oemezd 29 Paget's Disease, Mammary/ use prmz 30 (paget$ and (breast$ or mammary or nipple$)).tw or 24 or 25 or 26 or 27 or 28 or 29 or or (duct$ carcinoma$-in-situ or duct$ carcinoma$ in-situ or duct$ carcinoma$ in situ or DCIS).tw or Mastectomy, Segmental/ use prmz 36 partial mastectomy/ use oemezd 37 (segmentectom$ or post?segmentectom$).tw. 38 (lumpectom$ or post?lumpectom$).tw. 39 (quadrectom$ or post?quadrectom$).tw. 40 ((local or limited or sector or segment$ or partial) adj2 (excision or resection)).tw. 41 ((partial or segment$) adj2 (mammectom$ or mastectomy$)).tw. 42 (breast adj conserv$).mp. 43 breast?conserv$.mp. 44 (conserv$ adj2 (surgery or therapy)).tw. 45 excision alone.tw or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or Reoperation/ use prmz 48 reoperation/ use oemezd 49 (re-operat$ or reoperat$ or re-excis$ or reexcis$).tw. 50 Neoplasm Recurrence, Local/ use prmz 51 tumor recurrence/ use oemezd 52 (local adj (failure or relaps$ or recurrence$)).tw. 53 ipsilateral breast tumo?r recurren$.tw. 54 ipsilateral breast tumo?r relaps$.tw. 55 IBTR.tw. 56 (recurrence free survival or RFS).tw. 57 exp Patient Satisfaction/ use prmz 58 exp patient satisfaction/ use oemezd 59 (patient adj3 (satisf$ or attitude$ or preference$)).tw or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or margin$.tw and 46 and 60 and margin$.m_titl and 46 and or remove duplicates from 65 8

9 F.1.2 Database: Cochrane Library via Wiley Online Date of last search: 30 January 2017 #1 MeSH descriptor: [Breast Neoplasms] explode all trees #2 MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees #3 MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees #4 MeSH descriptor: [Carcinoma, Lobular] this term only #5 MeSH descriptor: [Carcinoma, Medullary] this term only #6 #1 or #2 or #3 or #4 or #5 #7 MeSH descriptor: [Breast] explode all trees #8 breast:ti,ab,kw (Word variations have been searched) #9 #7 or #8 #10 (breast next milk):ti,ab,kw (Word variations have been searched) #11 (breast next tender*):ti,ab,kw (Word variations have been searched) #12 #10 or #11 #13 #9 not #12 #14 MeSH descriptor: [Neoplasms] explode all trees #15 #13 and #14 #16 (breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #17 (mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #18 MeSH descriptor: [Paget's Disease, Mammary] this term only #19 (paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched) #20 #15 or #16 or #17 or #18 or #19 #21 #6 or #20 #22 MeSH descriptor: [Mastectomy, Segmental] this term only #23 (segmentectom* or post segmentectom* or post-segmentectom* or postsegmentectom*):ti,ab,kw (Word variations have been searched) #24 (lumpectom* or post lumpectom* or post-lumpectom* or postlumpectom*):ti,ab,kw (Word variations have been searched) #25 (quadrectom* or post quadrectom* or post-quadrectom* or postquadrectom*):ti,ab,kw (Word variations have been searched) #26 ((local or limited or sector or partial or segment$) near/2 (excision or resection)):ti,ab,kw (Word variations have been searched) #27 ((partial or segment*) near/2 (mammectom* or mastectomy*)):ti,ab,kw (Word variations have been searched) #28 (breast next conserv*):ti,ab,kw (Word variations have been searched) #29 (conserv* near/2 (surgery or therapy)):ti,ab,kw (Word variations have been searched) #30 excision alone:ti,ab,kw (Word variations have been searched) #31 #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 #32 MeSH descriptor: [Reoperation] explode all trees #33 (re-operat* or reoperat* or re-excis* or reexcis*):ti,ab,kw (Word variations have been searched) #34 MeSH descriptor: [Neoplasm Recurrence, Local] explode all trees #35 (local next (failure or relaps* or recurrence*)):ti,ab,kw (Word variations have been searched) #36 (ipsilateral near/3 (relaps* or recurren*)):ti,ab,kw (Word variations have been searched) 9

10 #37 IBTR:ti,ab,kw (Word variations have been searched) #38 (recurrence free survival or RFS):ti,ab,kw (Word variations have been searched) #39 MeSH descriptor: [Patient Satisfaction] explode all trees #40 (patient near/3 (satisf* or attitude* or preference*)):ti,ab,kw (Word variations have been searched) #41 #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39 or #40 #42 margin*:ti,ab,kw (Word variations have been searched) #43 #21 and #31 and #41 and #42 #44 margin*:ti (Word variations have been searched) #45 #21 and #31 and #44 #46 #43 or #45 F.2 Axillary treatment Review question: Is there a subgroup of people who do not need axillary treatment when the axilla has been found to contain metastatic disease? F.2.1 Database: Medline Last searched on: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present.] Date of last search: 26 September exp Breast Neoplasms/ 2 exp "Neoplasms, Ductal, Lobular, and Medullary"/ 3 exp Fibrocystic Breast Disease/ 4 or/1-3 5 exp Breast/ 6 breast.tw. 7 5 or 6 8 (breast adj milk).ti,ab,sh. 9 (breast adj tender$).ti,ab,sh or not exp Neoplasms/ and exp Lymphedema/ and (breast adj25 neoplasm$).ti,ab,sh. 17 (breast adj25 cancer$).ti,ab,sh. 18 (breast adj25 tumour$).ti,ab,sh. 19 (breast adj25 tumor$).ti,ab,sh. 20 (breast adj25 carcinoma$).ti,ab,sh. 21 (breast adj25 adenocarcinoma$).ti,ab,sh. 22 (breast adj25 sarcoma$).ti,ab,sh. 23 (breast adj50 dcis).ti,ab,sh. 10

11 24 (breast adj25 ductal).ti,ab,sh. 25 (breast adj25 infiltrating).ti,ab,sh. 26 (breast adj25 intraductal).ti,ab,sh. 27 (breast adj25 lobular).ti,ab,sh. 28 (breast adj25 medullary).ti,ab,sh. 29 or/ or 13 or 15 or exp Mastectomy/ or (mammary adj25 neoplasm$).ti,ab,sh. 34 (mammary adj25 cancer$).ti,ab,sh. 35 (mammary adj25 tumour$).ti,ab,sh. 36 (mammary adj25 tumor$).ti,ab,sh. 37 (mammary adj25 carcinoma$).ti,ab,sh. 38 (mammary adj25 adenocarcinoma$).ti,ab,sh. 39 (mammary adj25 sarcoma$).ti,ab,sh. 40 (mammary adj50 dcis).ti,ab,sh. 41 (mammary adj25 ductal).ti,ab,sh. 42 (mammary adj25 infiltrating).ti,ab,sh. 43 (mammary adj25 intraductal).ti,ab,sh. 44 (mammary adj25 lobular).ti,ab,sh. 45 (mammary adj25 medullary).ti,ab,sh. 46 or/ or exp Breast Self-Examination/ 49 (breast adj25 self$).ti,ab,sh. 50 (breast adj25 screen$).ti,ab,sh. 51 exp Mammography/ 52 or/ mammograph$.tw and or exp Sentinel Lymph Node Biopsy/ 57 (sentinel adj2 node).mp. 58 (SN or SNB or SLN or SLNB).mp. 59 exp Axilla/ 60 exp Neoplasm Staging/ 61 exp Lymph Node Excision/ 62 lymphadenectomy.mp. 63 (axill$ adj3 (surg$ or sampl$ or stag$)).mp. 64 ((block or lymph node or axillary) adj dissection).mp. 65 ((block or lymph node or axillary) adj clearance).mp. 66 or/ and Meta-Analysis/ 11

12 69 Meta-Analysis as Topic/ 70 (meta analy* or metanaly* or metaanaly*).ti,ab. 71 ((systematic* or evidence*) adj2 (review* or overview*)).ti,ab. 72 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 73 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 74 (search* adj4 literature).ab. 75 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 76 cochrane.jw or 69 or 70 or 71 or 72 or 73 or 74 or 75 or randomized controlled trial.pt. 79 controlled clinical trial.pt. 80 randomized controlled trials.sh. 81 random allocation.sh. 82 double-blind method.sh. 83 single-blind method.sh. 84 or/ clinical trial.pt. 86 exp Clinical Trials/ 87 (clin$ adj25 trial$).ti,ab. 88 ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab. 89 placebos.sh. 90 placebo$.ti,ab. 91 random$.ti,ab. 92 research design.sh. 93 or/ or and (animals not humans).sh not and or (2015* or 2016* or 2017*).dc,ed,yr and 100 [Then general exclusions filter applied] F.2.2 Database: Embase Last searched on Embase Classic+Embase 1947 to 2017 September 25. Date of last search: 26 September exp breast cancer/ 2 exp breast carcinoma/ 3 exp medullary carcinoma/ 4 exp intraductal carcinoma/ 5 exp breast tumor/ 12

13 6 1 or 2 or 3 or 4 or 5 7 exp breast/ 8 breast.tw. 9 7 or 8 10 (breast adj milk).tw. 11 (breast adj tender$).tw or not exp neoplasm/ and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 17 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 18 exp Paget nipple disease/ 19 (paget$ and (breast$ or mammary or nipple$)).tw or 16 or 17 or 18 or or exp sentinel lymph node biopsy/ 23 (sentinel adj2 node).mp. 24 (SN or SNB or SLN or SLNB).mp. 25 exp axilla/ 26 exp cancer staging/ 27 exp lymph node dissection/ 28 lymphadenectomy.mp. 29 (axill$ adj3 (surg$ or sampl$ or stag$)).mp. 30 ((block or lymph node or axillary) adj dissection).mp. 31 ((block or lymph node or axillary) adj clearance).mp or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or and systematic review/ 35 meta-analysis/ 36 (meta analy* or metanaly* or metaanaly*).ti,ab. 37 ((systematic or evidence) adj2 (review* or overview*)).ti,ab. 38 (reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab. 39 (search strategy or search criteria or systematic search or study selection or data extraction).ab. 40 (search* adj4 literature).ab. 41 (medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab. 42 ((pool* or combined) adj2 (data or trials or studies or results)).ab. 43 cochrane.jw or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or random*.ti,ab. 46 factorial*.ti,ab. 13

14 47 (crossover* or cross over*).ti,ab. 48 ((doubl* or singl*) adj blind*).ti,ab. 49 (assign* or allocat* or volunteer* or placebo*).ti,ab. 50 crossover procedure/ 51 single blind procedure/ 52 randomized controlled trial/ 53 double blind procedure/ or 46 or 47 or 48 or 49 or 50 or 51 or 52 or and and or (2015* or 2016* or 2017*).dd,em,yr and 58 [Then general exclusions filter applied] F.2.3 Database: Cochrane Library via Wiley Online Date of last search: 26 September 2017 #1 MeSH descriptor: [Breast Neoplasms] explode all trees #2 breast near cancer*:ti,ab,kw (Word variations have been searched) #3 breast near neoplasm*:ti,ab,kw (Word variations have been searched) #4 breast near carcinoma*:ti,ab,kw (Word variations have been searched) #5 breast near tumour*:ti,ab,kw (Word variations have been searched) #6 breast near tumor*:ti,ab,kw (Word variations have been searched) #7 #1 or #2 or #3 or #4 or #5 or #6 #8 MeSH descriptor: [Sentinel Lymph Node Biopsy] explode all trees #9 sentinel lymph node biopsy or SLNB or SNB or SLN or (sentinel near node):ti,ab,kw (Word variations have been searched) #10 MeSH descriptor: [Axilla] explode all trees #11 axilla* near (surg* or sampl* or stag*):ti,ab,kw (Word variations have been searched) #12 MeSH descriptor: [Neoplasm Staging] explode all trees #13 MeSH descriptor: [Lymph Node Excision] explode all trees #14 "lymphadenectomy":ti,ab,kw (Word variations have been searched) #15 (block or lymph node or axillary) near dissection:ti,ab,kw (Word variations have been searched) #16 (block or lymph node or axillary) near clearance:ti,ab,kw (Word variations have been searched) #17 #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 #18 #7 and #17 Publication Year from 2015 to 2017 F.3 Lymphoedema prevention Review question: What are the best strategies for preventing lymphoedema after axillary intervention? 14

15 F.3.1 Database: Medline & Embase (Multifile) Last searched on Embase 1974 to 2017 October 10, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present. Date of last search: 11 October exp breast cancer/ use oemezd 2 exp breast carcinoma/ use oemezd 3 exp medullary carcinoma/ use oemezd 4 exp intraductal carcinoma/ use oemezd 5 exp breast tumor/ use oemezd 6 exp Breast Neoplasms/ use prmz 7 exp "Neoplasms, Ductal, Lobular, and Medullary"/ use prmz 8 Carcinoma, Intraductal, Noninfiltrating/ use prmz 9 Carcinoma, Lobular/ use prmz 10 Carcinoma, Medullary/ use prmz 11 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or exp breast/ use oemezd 13 exp Breast/ use prmz 14 breast.tw or 13 or (breast adj milk).tw. 17 (breast adj tender$).tw or not exp neoplasm/ use oemezd 21 exp Neoplasms/ use prmz or and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. use oemezd 25 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. use oemezd 26 (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. use prmz 27 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. use prmz 28 exp Paget nipple disease/ use oemezd 29 Paget's Disease, Mammary/ use prmz 30 (paget$ and (breast$ or mammary or nipple$)).tw or 24 or 25 or 26 or 27 or 28 or 29 or or exp Lymphedema/ use prmz 34 exp lymphedema/ use oemezd 15

16 35 arm edema/ use oemezd 36 (arm$ adj4 (morbid$ or swell$ or swollen or pain$ or oedem$ or edem$)).mp. 37 (upper limb$ adj4 (morbid$ or swell$ or swollen or pain$ or oedem$ or edem$)).mp. 38 (lymph$ adj4 (oedem$ or edem$)).tw. 39 (lymph?ed$ or elephantiasis).mp. 40 Edema/ use prmz 41 edema/ use oemezd 42 (upper limb$ or arm$).mp or and or 34 or 35 or 36 or 37 or 38 or 39 or and limit 46 to yr="2008 -Current" [Then general exclusions filter applied] F.3.2 Database: Cochrane Library via Wiley Online Date of last search: 11 October 2017 #1 MeSH descriptor: [Breast Neoplasms] explode all trees #2 MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees #3 MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees #4 MeSH descriptor: [Carcinoma, Lobular] this term only #5 MeSH descriptor: [Carcinoma, Medullary] this term only #6 #1 or #2 or #3 or #4 or #5 #7 MeSH descriptor: [Breast] explode all trees #8 breast:ti,ab,kw (Word variations have been searched) #9 #7 or #8 #10 (breast next milk):ti,ab,kw (Word variations have been searched) #11 (breast next tender*):ti,ab,kw (Word variations have been searched) #12 #10 or #11 #13 #9 not #12 #14 MeSH descriptor: [Neoplasms] explode all trees #15 #13 and #14 #16 (breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #17 (mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #18 MeSH descriptor: [Paget's Disease, Mammary] this term only #19 (paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched) #20 #15 or #16 or #17 or #18 or #19 #21 #6 or #20 #22 MeSH descriptor: [Lymphedema] explode all trees #23 (lymphed* or lymphoed* or elephantiasis):ti,ab,kw (Word variations have been searched) #24 (arm* near/4 (morbid* or swell* or swollen or pain* or oedem* or edem*)):ti,ab,kw (Word 16

17 variations have been searched) #25 (upper limb* near/4 (morbid* or swell* or swollen or pain* or oedem* or edem*)):ti,ab,kw (Word variations have been searched) #26 (lymph* near/4 (oedem* or edem*)):ti,ab,kw (Word variations have been searched) #27 MeSH descriptor: [Edema] explode all trees #28 (upper limb* or arm*):ti,ab,kw (Word variations have been searched) #29 #27 and #28 #30 #22 or #23 or #24 or #25 or #26 or #29 #31 #21 and #30 Publication Year from 2008 to 2017 F.3.3 Database: Cinahl Plus Date of last search: 11 October 2017 S8 S3 AND S6 [Limiters - Publication Year: ] S7 S6 S5 S4 S3 S2 S1 S3 AND S6 S4 OR S5 ( ( TI lymphoedema or AB lymphoedema ) or ( TI lymphedema or AB lymphedema ) or ( TI lymph* edema or AB lymph* edema ) ) or ( TI elephantiasis or AB elephantiasis ) ) (MM "Lymphedema") S1 OR S2 ( ( TI breast cancer* or AB breast cancer* ) or ( TI breast tumor* or AB breast tumor* ) ) or ( ( TI breast tumour* or AB breast tumour* ) or ( TI mammary neoplasm* or AB mammary neoplasm* ) or ( TI mammary carcinoma* or AB mammary carcinoma* ) or ( TI breast neoplasm* or AB breast neoplasm* ) or ( TI breast carcinoma* or AB breast carcinoma* ) ) (MM "Breast Neoplasms") F.3.4 Database: AMED Last searched on OVID AMED (Allied and Complementary Medicine) 1985 to present. Date of last search: 11 October exp breast neoplasms/ 2 (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 3 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 4 (paget$ and (breast$ or mammary or nipple$)).tw. 5 1 or 2 or 3 or 4 6 exp Lymphedema/ 7 (lymph?ed$ or elephantiasis).tw. 8 (arm$ adj4 (morbid$ or swell$ or swollen or pain$ or oedem$ or edem$)).tw. 9 (upper limb$ adj4 (morbid$ or swell$ or swollen or pain$ or oedem$ or edem$)).tw. 10 (lymph$ adj4 (oedem$ or edem$)).tw. 11 Edema/ 12 (upper limb$ or arm$).tw. 17

18 13 11 and or 7 or 8 or 9 or 10 or and limit 15 to yr="2008 -Current" F.3.5 Database: PsycINFO Last searched on OVID PsycINFO 1806 to present. Date of last search: 11 October exp breast neoplasms/ 2 (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 3 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 4 (paget$ and (breast$ or mammary or nipple$)).tw. 5 1 or 2 or 3 or 4 6 exp Lymphedema/ 7 (lymph?ed$ or elephantiasis).tw. 8 (arm$ adj4 (morbid$ or swell$ or swollen or pain$ or oedem$ or edem$)).tw. 9 (upper limb$ adj4 (morbid$ or swell$ or swollen or pain$ or oedem$ or edem$)).tw. 10 (lymph$ adj4 (oedem$ or edem$)).tw. 11 Edema/ 12 (upper limb$ or arm$).tw and or 7 or 8 or 9 or 10 or and limit 15 to yr="2008 -Current" F.4 Progesterone receptor testing Review question: Is there a benefit of progesterone receptor (PR) testing for adjuvant chemotherapy planning? F.4.1 Database: Medline & Embase (Multifile) Last searched on Embase 1974 to 2017 March 03, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present. Date of last search: 6 March exp breast cancer/ use oemezd 2 exp breast carcinoma/ use oemezd 3 exp medullary carcinoma/ use oemezd 4 exp intraductal carcinoma/ use oemezd 5 exp breast tumor/ use oemezd 18

19 6 exp Breast Neoplasms/ use prmz 7 exp "Neoplasms, Ductal, Lobular, and Medullary"/ use prmz 8 Carcinoma, Intraductal, Noninfiltrating/ use prmz 9 Carcinoma, Lobular/ use prmz 10 Carcinoma, Medullary/ use prmz 11 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or exp breast/ use oemezd 13 exp Breast/ use prmz 14 breast.tw or 13 or (breast adj milk).tw. 17 (breast adj tender$).tw or not exp neoplasm/ use oemezd 21 exp Neoplasms/ use prmz or and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).tw. use oemezd 25 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).tw. use oemezd 26 (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).mp. use prmz 27 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or sarcoma$ or leiomyosarcoma$ or dcis or duct$ or infiltrat$ or intraduct$ or lobul$ or medullary or tubular)).mp. use prmz 28 exp Paget nipple disease/ use oemezd 29 Paget's Disease, Mammary/ use prmz 30 (paget$ and (breast$ or mammary or nipple$)).tw or 24 or 25 or 26 or 27 or 28 or 29 or or Receptors, Progesterone/ use prmz 34 progesterone receptor/ use oemezd 35 ((progesteron$ or progestin or PgR or PR) adj3 (status or test$ or level$ or receptor$ or expression)).ti,ab. 36 ((PR adj2 positiv$) or (PR adj2 negativ$) or (PgR adj2 positiv$) or (PgR adj2 negativ$) or (progesteron$ adj2 positiv$) or (progesteron$ adj2 negativ$) or (progestin adj2 negativ$) or (progestin adj2 positiv$)).ti,ab. 37 (progesteron$ or progestin or PgR or PR).m_titl or 34 or 35 or 36 or and limit 39 to yr="1984 -Current" 41 limit 40 to RCTs and SRs, and general exclusions filter applied 19

20 F.4.2 Database: Cochrane Library via Wiley Online Date of last search: 6 March #1 MeSH descriptor: [Breast Neoplasms] explode all trees #2 MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees #3 MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees #4 MeSH descriptor: [Carcinoma, Lobular] this term only #5 MeSH descriptor: [Carcinoma, Medullary] this term only #6 #1 or #2 or #3 or #4 or #5 #7 MeSH descriptor: [Breast] explode all trees #8 breast:ti,ab,kw (Word variations have been searched) #9 #7 or #8 #10 (breast next milk):ti,ab,kw (Word variations have been searched) #11 (breast next tender*):ti,ab,kw (Word variations have been searched) #12 #10 or #11 #13 #9 not #12 #14 MeSH descriptor: [Neoplasms] explode all trees #15 #13 and #14 #16 (breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #17 (mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #18 MeSH descriptor: [Paget's Disease, Mammary] this term only #19 (paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched) #20 #15 or #16 or #17 or #18 or #19 #21 #6 or #20 #22 MeSH descriptor: [Receptors, Progesterone] explode all trees #23 ((progesteron* or progestin or PgR or PR) near/3 (status or test* or level* or receptor* or expression)):ti,ab,kw (Word variations have been searched) #24 ((PR near/2 positiv*) or (PR near/2 negativ*) or (PgR near/2 positiv*) or (PgR near/2 negativ*) or (progesteron* near/2 positiv*) or (progesteron* near/2 negativ*) or (progestin near/2 negativ*) or (progestin near/2 positiv*)):ti,ab,kw (Word variations have been searched) #25 (progesterone* or progestin or PgR or PR):ti (Word variations have been searched) #26 #22 or #23 or #24 or #25 #27 #21 and #26 F.5 Prognostic tools Review question: What predictive prognostic tools, excluding gene profiling tests, should be used for determining adjuvant systemic therapy? F.5.1 Database: Medline & Embase (Multifile) Last searched on Embase 1974 to 2017 September 20, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present. 20

21 Date of last search: 22 September exp breast cancer/ use oemezd 2 exp breast carcinoma/ use oemezd 3 exp medullary carcinoma/ use oemezd 4 exp intraductal carcinoma/ use oemezd 5 exp breast tumor/ use oemezd 6 exp Breast Neoplasms/ use prmz 7 exp "Neoplasms, Ductal, Lobular, and Medullary"/ use prmz 8 Carcinoma, Intraductal, Noninfiltrating/ use prmz 9 Carcinoma, Lobular/ use prmz 10 Carcinoma, Medullary/ use prmz 11 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or exp breast/ use oemezd 13 exp Breast/ use prmz 14 breast.tw or 13 or (breast adj milk).tw. 17 (breast adj tender$).tw or not exp neoplasm/ use oemezd 21 exp Neoplasms/ use prmz or and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. use oemezd 25 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. use oemezd 26 (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. use prmz 27 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. use prmz 28 exp Paget nipple disease/ use oemezd 29 Paget's Disease, Mammary/ use prmz 30 (paget$ and (breast$ or mammary or nipple$)).tw or 24 or 25 or 26 or 27 or 28 or 29 or or (adjuvant$ adj (online or model$ or program$ or tool$)).tw. 34 " 35 adjuvant?online$.tw. 36 (PREDICT adj2 (online or model$ or program$ or tool$ or estimat$)).tw. 37 " 38 (predict adj plus).tw. 21

22 39 (prognost$ adj index).tw. 40 "Nottingham Prognostic Index".tw. 41 NPI.tw. 42 FinProg$.tw. 43 CancerMath$.tw. 44 " or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or and limit 46 to yr="1982 -Current" 48 decision support system/ use oemezd 49 Decision Making, Computer-Assisted/ use prmz 50 computer/ use oemezd 51 Computers/ use prmz 52 clinical decision support system/ use oemezd 53 Decision Support Systems, Clinical/ use prmz 54 computer program/ use oemezd 55 Software/ use prmz 56 Decision Support Techniques/ use prmz 57 *decision making/ use oemezd 58 medical decision making/ use oemezd 59 clinical decision making/ use oemezd 60 Decision Making/ use prmz or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or adjuvant$.tw and 61 and limit 63 to yr="2007 -Current" 65 survival/ use oemezd 66 survival analysis/ use prmz or Internet/ use prmz 69 internet/ use oemezd 70 Databases, factual/ use prmz 71 *data base/ use oemezd 72 Online systems/ use prmz 73 online system/ use oemezd 74 Web browser/ use prmz 75 web browser/ use oemezd 76 User computer interface/ use prmz 77 computer interface/ use oemezd or 69 or 70 or 71 or 72 or 73 or 74 or 75 or 76 or and 67 and limit 79 to yr="1982 -Current" or 64 or remove duplicates from 81 [Then general exclusions filter applied] 22

23 F.5.2 Database: Cochrane Library via Wiley Online Date of last search: 22 September #1 MeSH descriptor: [Breast Neoplasms] explode all trees #2 MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees #3 MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees #4 MeSH descriptor: [Carcinoma, Lobular] this term only #5 MeSH descriptor: [Carcinoma, Medullary] this term only #6 #1 or #2 or #3 or #4 or #5 #7 MeSH descriptor: [Breast] explode all trees #8 breast:ti,ab,kw (Word variations have been searched) #9 #7 or #8 #10 (breast next milk):ti,ab,kw (Word variations have been searched) #11 (breast next tender*):ti,ab,kw (Word variations have been searched) #12 #10 or #11 #13 #9 not #12 #14 MeSH descriptor: [Neoplasms] explode all trees #15 #13 and #14 #16 (breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #17 (mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #18 MeSH descriptor: [Paget's Disease, Mammary] this term only #19 (paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched) #20 #15 or #16 or #17 or #18 or #19 #21 #6 or #20 #22 (adjuvant* next (online or model* or program* or tool*)):ti,ab,kw (Word variations have been searched) #23 " (Word variations have been searched) #24 adjuvantonline*:ti,ab,kw (Word variations have been searched) #25 (PREDICT near/2 (online or model* or program* or tool* or estimat*)):ti,ab,kw (Word variations have been searched) #26 " (Word variations have been searched) #27 (predict next plus):ti,ab,kw (Word variations have been searched) #28 (prognost* next index):ti,ab,kw (Word variations have been searched) #29 "Nottingham Prognostic Index":ti,ab,kw (Word variations have been searched) #30 NPI:ti,ab,kw (Word variations have been searched) #31 FinProg*:ti,ab,kw (Word variations have been searched) #32 CancerMath*:ti,ab,kw (Word variations have been searched) #33 " (Word variations have been searched) #34 #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 #35 #21 and #34 Publication Year from 1982 to 2017 #36 MeSH descriptor: [Decision Making, Computer-Assisted] explode all trees #37 MeSH descriptor: [Computers] explode all trees #38 MeSH descriptor: [Decision Support Systems, Clinical] explode all trees 23

24 #39 MeSH descriptor: [Software] explode all trees #40 MeSH descriptor: [Decision Support Techniques] explode all trees #41 MeSH descriptor: [Decision Making] explode all trees #42 #36 or #37 or #38 or #39 or #40 or #41 #43 adjuvant*:ti,ab,kw (Word variations have been searched) #44 #21 and #42 and #43 Publication Year from 2007 to 2017 #45 MeSH descriptor: [Survival Analysis] explode all trees #46 MeSH descriptor: [Internet] explode all trees #47 MeSH descriptor: [Databases, Factual] explode all trees #48 MeSH descriptor: [Online Systems] explode all trees #49 MeSH descriptor: [Web Browser] explode all trees #50 MeSH descriptor: [User-Computer Interface] explode all trees #51 #46 or #47 or #48 or #49 or #50 #52 #21 and #45 and #51 Publication Year from 1982 to 2017 #53 #35 or #44 or #52 F.6 Duration of endocrine therapy Review question: What is the optimal duration of adjuvant endocrine therapy for people with oestrogen-receptor positive breast cancer? F.6.1 Database: Medline Last searched on Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present. Date of last search: 27 September exp Breast Neoplasms/ 2 exp "Neoplasms, Ductal, Lobular, and Medullary"/ 3 Carcinoma, Intraductal, Noninfiltrating/ 4 Carcinoma, Lobular/ 5 Carcinoma, Medullary/ 6 1 or 2 or 3 or 4 or 5 7 exp Breast/ 8 breast.tw. 9 7 or 8 10 (breast adj milk).tw. 11 (breast adj tender$).tw or not exp Neoplasms/ and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. 17 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or 24

25 tubular)).mp. 18 Paget's Disease, Mammary/ 19 (paget$ and (breast$ or mammary or nipple$)).tw or 16 or 17 or 18 or or exp Aromatase Inhibitors/ 23 aromatase inhibitor$.mp. 24 anastrazole.mp. 25 arimidex.mp. 26 letrozole.mp. 27 femara.mp. 28 exemestane.mp. 29 aromasin.mp. 30 Tamoxifen/ 31 (Nolvadex or tamoxifen$).mp. 32 or/ and Time Factors/ 35 (duration$ or timing).tw. 36 (sequenc$ or sequential).tw. 37 extended.tw. 38 (continu$ or stop$).tw. 39 ((optimal or different) adj (regimen$ or treatment or therapy or course)).tw. 40 (length adj2 (regimen$ or treatment or therapy or course)).tw. 41 or/ and ("MA.17" or MA17 or ATTOM or ATLAS).tw and or limit 45 to yr="1996 -Current" 47 Limit 46 to RCTs and SRs, and general exclusions filter applied F.6.2 Database: Embase Last searched on Embase Classic+Embase 1947 to 2017 September 26. Date of last search: 27 September exp breast cancer/ 2 exp breast carcinoma/ 3 exp medullary carcinoma/ 4 exp intraductal carcinoma/ 5 exp breast tumor/ 6 1 or 2 or 3 or 4 or 5 7 exp breast/ 8 breast.tw. 25

26 9 7 or 8 10 (breast adj milk).tw. 11 (breast adj tender$).tw or not exp neoplasm/ and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 17 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 18 exp Paget nipple disease/ 19 (paget$ and (breast$ or mammary or nipple$)).tw or 16 or 17 or 18 or or exp aromatase inhibitor/ 23 aromatase inhibitor$.mp. 24 anastrazole.mp. 25 arimidex.mp. 26 letrozole.mp. 27 femara.mp. 28 exemestane.mp. 29 aromasin.mp. 30 tamoxifen/ 31 (Nolvadex or tamoxifen$).mp. 32 or/ and time factor/ 35 (duration$ or timing).tw. 36 (sequenc$ or sequential).tw. 37 extended.tw. 38 (continu$ or stop$).tw. 39 ((optimal or different) adj (regimen$ or treatment or therapy or course)).tw. 40 (length adj2 (regimen$ or treatment or therapy or course)).tw. 41 or/ and ("MA.17" or MA17 or ATTOM or ATLAS).tw and or limit 45 to yr="1996 -Current" 47 Limit 46 to RCTs and SRs, and general exclusions filter applied F.6.3 Database: Cochrane Library via Wiley Online Date of last search: 27 September

27 #1 MeSH descriptor: [Breast Neoplasms] explode all trees #2 MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees #3 MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees #4 MeSH descriptor: [Carcinoma, Lobular] this term only #5 MeSH descriptor: [Carcinoma, Medullary] this term only #6 #1 or #2 or #3 or #4 or #5 #7 MeSH descriptor: [Breast] explode all trees #8 breast:ti,ab,kw (Word variations have been searched) #9 #7 or #8 #10 (breast next milk):ti,ab,kw (Word variations have been searched) #11 (breast next tender*):ti,ab,kw (Word variations have been searched) #12 #10 or #11 #13 #9 not #12 #14 MeSH descriptor: [Neoplasms] explode all trees #15 #13 and #14 #16 (breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #17 (mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #18 MeSH descriptor: [Paget's Disease, Mammary] this term only #19 (paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched) #20 #15 or #16 or #17 or #18 or #19 #21 #6 or #20 #22 MeSH descriptor: [Aromatase Inhibitors] explode all trees #23 aromatase inhibitor*:ti,ab,kw (Word variations have been searched) #24 (anastrazole or arimidex or letrozole or femara or exemestane or aromasin):ti,ab,kw (Word variations have been searched) #25 MeSH descriptor: [Tamoxifen] this term only #26 (Nolvadex or tamoxifen*):ti,ab,kw (Word variations have been searched) #27 #22 or #23 or #24 or #25 or #26 #28 #21 and #27 #29 MeSH descriptor: [Time Factors] this term only #30 (duration* or timing):ti,ab,kw (Word variations have been searched) #31 (sequenc* or sequential):ti,ab,kw (Word variations have been searched) #32 extended:ti,ab,kw (Word variations have been searched) #33 (continu* or stop*):ti,ab,kw (Word variations have been searched) #34 ((optimal or different) next (regimen* or treatment or therapy or course)):ti,ab,kw (Word variations have been searched) #35 (length near/2 (regimen* or treatment or therapy or course)):ti,ab,kw (Word variations have been searched) #36 #29 or #30 or #31 or #32 or #33 or #34 or #35 #37 #28 and #36 #38 (MA.17 or MA17 or ATTOM or ATLAS):ti,ab,kw (Word variations have been searched) #39 #21 and #38 #40 #37 or #39 Publication Year from 1996 to

28 F.7 Ovarian suppression Review question: What is the effectiveness of ovarian suppression in addition to endocrine therapy in pre-menopausal women with oestrogen-positive breast cancer? F.7.1 Database: Medline Last searched on Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present. Date of last search: 28 September exp Breast Neoplasms/ 2 exp "Neoplasms, Ductal, Lobular, and Medullary"/ 3 Carcinoma, Intraductal, Noninfiltrating/ 4 Carcinoma, Lobular/ 5 Carcinoma, Medullary/ 6 1 or 2 or 3 or 4 or 5 7 exp Breast/ 8 breast.tw. 9 7 or 8 10 (breast adj milk).tw. 11 (breast adj tender$).tw or not exp Neoplasms/ and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. 17 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).mp. 18 Paget's Disease, Mammary/ 19 (paget$ and (breast$ or mammary or nipple$)).tw or 16 or 17 or 18 or or exp Ovariectomy/ 23 (ovariectom$ or oophorectom$).ti,ab. 24 (removal adj3 ovar$).ti,ab. 25 ((radiation or irradiation or radiotherap$) adj3 ovar$).ti,ab. 26 exp Ovary/ 27 exp Radiation/ 28 (ovar$ adj3 (suppress$ or ablat$)).ti,ab and or 23 or 24 or 25 or 28 or and Luteinizing Hormone/ 33 lutein$ hormon$ releas$.mp. 28

29 34 (LHRH$ or LH-RH$).mp. 35 exp Gonadotropin-Releasing Hormone/ 36 gonadotrop$ releas$ hormon$.mp. 37 (GnRH$ or GnRHA$).mp. 38 (goserelin$ or zolade$ or novgos or buserelin$ or suprefact or suprecur or leuprolid$ or leuprorelin$ or lupron or nafarelin$ or synarel or triptorelin$ or decapeptyl or gonapeptyl).mp. 39 (hormon$ adj3 (suppress$ or ablat$)).mp or 33 or 34 or 35 or 36 or 37 or 38 or and or limit 42 to yr="1992 -Current" 44 Limit 43 to RCTs and SRs, and general exclusions filter applied F.7.2 Database: Embase Last searched on Embase Classic+Embase 1947 to 2017 September 27. Date of last search: 28 September exp breast cancer/ 2 exp breast carcinoma/ 3 exp medullary carcinoma/ 4 exp intraductal carcinoma/ 5 exp breast tumor/ 6 1 or 2 or 3 or 4 or 5 7 exp breast/ 8 breast.tw. 9 7 or 8 10 (breast adj milk).tw. 11 (breast adj tender$).tw or not exp neoplasm/ and (breast$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 17 (mammar$ adj5 (neoplasm$ or cancer$ or tumo?r$ or carcinoma$ or adenocarcinoma$ or or tubular)).tw. 18 exp Paget nipple disease/ 19 (paget$ and (breast$ or mammary or nipple$)).tw or 16 or 17 or 18 or or exp ovariectomy/ 23 (ovariectom$ or oophorectom$).ti,ab. 24 (removal adj3 ovar$).ti,ab. 29

30 25 ((radiation or irradiation or radiotherap$) adj3 ovar$).ti,ab. 26 exp ovary/ 27 exp radiation/ 28 (ovar$ adj3 (suppress$ or ablat$)).ti,ab and or 23 or 24 or 25 or 28 or and exp gonadorelin/ 33 lutein$ hormon$ releas$.mp. 34 (LHRH$ or LH-RH$).mp. 35 exp growth hormone releasing factor/ 36 gonadotrop$ releas$ hormon$.mp. 37 (GnRH$ or GnRHA$).mp. 38 (goserelin$ or zolade$ or novgos or buserelin$ or suprefact or suprecur or leuprolid$ or leuprorelin$ or lupron or nafarelin$ or synarel or triptorelin$ or decapeptyl or gonapeptyl).mp. 39 (hormon$ adj3 (suppress$ or ablat$)).mp or 33 or 34 or 35 or 36 or 37 or 38 or and or limit 42 to yr="1992 -Current" 44 Limit 43 to RCTs and SRs, and general exclusions filter applied F.7.3 Database: Cochrane Library via Wiley Online Date of last search: 28 September 2017 #1 MeSH descriptor: [Breast Neoplasms] explode all trees #2 MeSH descriptor: [Neoplasms, Ductal, Lobular, and Medullary] explode all trees #3 MeSH descriptor: [Carcinoma, Intraductal, Noninfiltrating] explode all trees #4 MeSH descriptor: [Carcinoma, Lobular] this term only #5 MeSH descriptor: [Carcinoma, Medullary] this term only #6 #1 or #2 or #3 or #4 or #5 #7 MeSH descriptor: [Breast] explode all trees #8 breast:ti,ab,kw (Word variations have been searched) #9 #7 or #8 #10 (breast next milk):ti,ab,kw (Word variations have been searched) #11 (breast next tender*):ti,ab,kw (Word variations have been searched) #12 #10 or #11 #13 #9 not #12 #14 MeSH descriptor: [Neoplasms] explode all trees #15 #13 and #14 #16 (breast* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) #17 (mammar* near/5 (neoplasm* or cancer* or tumo?r* or carcinoma* or adenocarcinoma* or sarcoma* or leiomyosarcoma* or dcis or duct* or infiltrat* or intraduct* or lobul* or medullary or tubular)):ti,ab,kw (Word variations have been searched) 30

31 #18 MeSH descriptor: [Paget's Disease, Mammary] this term only #19 (paget* and (breast* or mammary or nipple*)):ti,ab,kw (Word variations have been searched) #20 #15 or #16 or #17 or #18 or #19 #21 #6 or #20 #22 MeSH descriptor: [Ovariectomy] explode all trees #23 (ovariectom* or oophorectom*):ti,ab,kw (Word variations have been searched) #24 (removal near/3 ovar*):ti,ab,kw (Word variations have been searched) #25 ((radiation or irradiation or radiotherap*) near/3 ovar*):ti,ab,kw (Word variations have been searched) #26 MeSH descriptor: [Ovary] explode all trees #27 MeSH descriptor: [Radiation] explode all trees #28 (ovar* near/3 (suppress* or ablat*)):ti,ab,kw (Word variations have been searched) #29 #26 and #27 #30 #22 or #23 or #24 or #25 or #28 or #29 #31 #21 and #30 #32 MeSH descriptor: [Luteinizing Hormone] explode all trees #33 lutein* hormon* releas*:ti,ab,kw (Word variations have been searched) #34 (LHRH* or LH-RH*):ti,ab,kw (Word variations have been searched) #35 MeSH descriptor: [Gonadotropin-Releasing Hormone] explode all trees #36 gonadotrop* releas* hormon*:ti,ab,kw (Word variations have been searched) #37 (GnRH* or GnRHA*):ti,ab,kw (Word variations have been searched) #38 (goserelin* or zolade* or novgos or buserelin* or suprefact or suprecur or leuprolid* or leuprorelin* or lupron or nafarelin* or synarel or triptorelin* or decapeptyl or gonapeptyl):ti,ab,kw (Word variations have been searched) #39 (hormon* near/3 (suppress* or ablat*)):ti,ab,kw (Word variations have been searched) #40 #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39 #41 #21 and #40 #42 #31 or #41 Publication Year from 1992 to 2016 F.8 Chemoprevention Review question: What is the role of chemoprevention in women following initial treatment for ductal carcinoma in situ (DCIS)? F.8.1 Database: Medline & Embase (Multifile) Last searched on Embase 1974 to 2017 March 28, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1946 to Present. Date of last search: 29 March exp breast cancer/ use oemezd 2 exp breast carcinoma/ use oemezd 3 exp medullary carcinoma/ use oemezd 4 exp intraductal carcinoma/ use oemezd 5 exp breast tumor/ use oemezd 6 exp Breast Neoplasms/ use prmz 31