Cancer stage and type		Primary treatment	Node evaluation	Adjuvant therapy
				Hormone receptor negative	Hormone receptor positive	ERBB2 overexpression
Stage 0: in situ
	Lobular carcinoma in situ	No treatment or consider prophylaxis with tamoxifen6	—	—	—	—
	Ductal carcinoma in situ	Breast-conserving surgery (consider mastectomy if extensive or multifocal) and radiation therapy	—	—	—	—
Stages I and II: early-stage invasive		Breast-conserving surgery7 and radiation therapy8	SLN biopsy9–11 or ALN dissection*	Chemotherapy†	Chemotherapy and endocrine therapy12	Chemotherapy and trastuzumab (Herceptin)13,14
Stage III: locally advanced
	Noninflammatory	Induction chemo-therapy,15 followed by breast-conserving surgery‡16–19 and radiation therapy	ALN dissection or SLN biopsy20	Induction chemotherapy15,21	Induction chemotherapy and post-operative endocrine therapy	Induction chemotherapy and postoperative trastuzumab
	Inflammatory	Induction chemotherapy, followed by mastectomy and radiation therapy	ALN dissection
Stage IV: metastatic
	Initial or recurrent	Address patient’s treatment goals; radiation therapy or bisphosphonates for bone pain	—	Chemotherapy	Endocrine therapy with or without chemotherapy	Trastuzumab with or without chemotherapy
Recurrent
	Local after breast- conserving surgery	Mastectomy	ALN dissection§	Chemotherapy||	Chemotherapy and endocrine therapy¶	Chemotherapy and trastuzumab
	Local after mastectomy	Wide excision	ALN dissection**
	Local inoperable	Induction chemotherapy	ALN dissection