The National Institute for Health and Clinical Excellence (NICE) has issued a clinical guideline for the management of patients with early and locally advanced breast cancer.

This guideline covers tests and treatments that patients with early and locally advanced breast cancer should be offered, in particular:
• reducing the amount of surgery
• breast reconstruction when breast conservation is not possible
• chemotherapy and endocrine treatments, and
• biological treatments.

In terms of medical management, NICE makes the following recommendations for the various options (all taken directly from source); With respect to adjuvant therapy, NICE recommends:
• Consider adjuvant therapy for all patients with early invasive breast cancer after surgery
• Start adjuvant chemotherapy or radiotherapy as soon as clinically possible within 31 days of completion of surgery in patients with early breast cancer having these treatments.

With respect to ovarian suppression/ablation for early invasive breast cancer, NICE recommends:

• Do not offer adjuvant ovarian ablation/suppression to premenopausal women with ER-positive early invasive breast cancer who are being treated with tamoxifen and, if indicated, chemotherapy.
• Offer adjuvant ovarian ablation/suppression in addition to tamoxifen to premenopausal women with ER-positive early invasive breast cancer who have been offered chemotherapy but have chosen not to have it.

With respect to aromatase inhibitors for early invasive breast cancer, NICE recommends:
• Postmenopausal women with ER-positive early invasive breast cancer who are not considered to be at low risk should be offered an aromatase inhibitor, either anastrozole or letrozole, as their initial adjuvant therapy. Offer tamoxifen if an aromatase inhibitor is not tolerated or contraindicated.
• Offer an aromatase inhibitor, either exemestane or anastrozole, instead of tamoxifen to postmenopausal women with ER-positive early invasive breast cancer who are not low risk and who have been treated with tamoxifen for 2–3 years.
• Offer additional treatment with the aromatase inhibitor letrozole for 2–3 years to postmenopausal women with lymph node-positive ER-positive early invasive breast cancer who have been treated with tamoxifen for 5 years.
• The aromatase inhibitors anastrozole, exemestane and letrozole, within their licensed indications, are recommended as options for the adjuvant treatment of early ER-positive invasive breast cancer in postmenopausal women
• The choice of treatment should be made after discussion between the responsible clinician and the woman about the risks and benefits of each option. Factors to consider when making the choice include whether the woman has received tamoxifen before, the licensed indications and side-effect profiles of the individual drugs and, in particular, the assessed risk of recurrence

With respect to chemotherapy, NICE recommends:
• Offer docetaxel to patients with lymph node-positive breast cancer as part of an adjuvant chemotherapy regimen.
• Do not offer paclitaxel as an adjuvant treatment for lymph node-positive breast cancer.

Finally, with respect to trastuzumab as biological therapy, NICE recommends:
• Offer trastuzumab, given at 3-week intervals for 1 year or until disease recurrence (whichever is the shorter period), as an adjuvant treatment to women with HER2-positive early invasive breast cancer following surgery, chemotherapy, and radiotherapy when applicable.
• Assess cardiac function before starting treatment with trastuzumab.
• Repeat cardiac functional assessments every 3 months during trastuzumab treatment. If the LVEF drops by 10% (ejection) points or more from baseline and to below 50% then trastuzumab treatment should be suspended. Restart trastuzumab therapy only after further cardiac assessment and a fully informed discussion of the risks and benefits with the woman.

Please see link below for further details of management of complications.