Objectives
  • To be able to perform specialist assessment, treatment and counselling of patients with breast cancer, including genetics, as well as prevention, early detection and screening

Awareness
  • Awareness of the existence of different molecular subtypes of breast cancer defined by genomic testing and immunohistochemistry (IHC) surrogates, and their implications in terms of prognosis and selection of appropriate therapies

  • Awareness of the existence of different pathological subtypes of breast cancer, namely rare histological subtypes and implications for prognosis and treatment

  • Awareness of the existence of BReast CAncer (BRCA)-related breast cancer and implications for surveillance of carriers, diagnosis and treatment

  • Awareness of the existence of indications for screening as well as best imaging tools

  • Recognition of the availability of different diagnostic and staging procedures, including imaging and pathology

  • Appreciation of the existence of different prognostic and predictive factors

  • Appreciation of the importance of the multidisciplinary approach to manage patients with breast cancer, in the early and the metastatic settings

  • Awareness of the existence of different therapeutic modalities namely surgery, radiotherapy, systemic therapies (chemotherapy, hormonal therapy and targeted therapy), as well as specialties such as physical therapy to manage lymphoedema

  • Awareness of the existence of indications for adequate follow-up of patients, including tackling issues of survivorship

  • Recognition of the existence of breast cancer in male patients

  • Awareness of international guidelines for the management of patients with breast cancer

Knowledge
  • Familiarity with the implications of the different molecular subtypes of breast cancer in terms of prognosis and selection of appropriate therapies

  • Familiarity with the implications of the different pathological subtypes of breast cancer, namely rare histological subtypes, in terms of prognosis and selection of appropriate therapies

  • Familiarity with the indications for screening as well as best imaging tools

  • Understanding of the principles of chemoprevention, its indications and side effects

  • Understanding of the indications for referring patients and their relatives for genetic counselling and testing and the implications of BRCA positivity in the management of carriers and patients

  • Familiarity with the indications and limitations of the different diagnostic tools available for breast cancer, including different imaging techniques (mammography, ultrasound, magnetic resonance imaging (MRI)) and pathology (fine needle aspiration (FNA) and core biopsy), as well as best staging procedures

  • Familiarity with the risk assessment work-up of prognostic factors, including staging and biological markers (hormone and human epidermal growth factor (HER-2) receptors)

  • Familiarity with the indications, value, modalities and limitations of surgery and radiotherapy for breast cancer, in all stages, as well as with the different possible sequences

  • Knowledge regarding types of systemic therapy (hormonal therapy, chemotherapy and targeted therapy), different regimens, their indications and main side effects for early and advanced disease

  • Knowledge about indications, objectives and limitations of neoadjuvant, ie, preoperative systemic therapy

  • Understanding of the criteria, clinical and biological, for decisions about adjuvant chemotherapy, including genomic tests and their indications and limitations

  • Understanding of the different goals of treatment and their implications for early and advanced disease

  • Understanding of the most common long-term side effects and other survivorship issues, including psychological, that affect patients who had a diagnosis of breast cancer, as well as those living with metastatic disease

  • Understanding of the complications that derive from disease progression and those that are treatment-associated in the context of being familiar with supportive and palliative care strategies

  • Understanding of the characteristics of breast cancer in male patients and main management procedures

  • Understanding of the indications and limitations of follow-up procedures for patients with breast cancer

  • Understanding how to evaluate response in the neoadjuvant and the advanced setting

Skills
  • Ability to contribute actively to a variety of breast cancer clinical scenarios and patient presentations

  • Ability to discuss critically the treatment options/recommendations

  • Ability to perform a history and physical examination in patients with breast cancer, including different subtypes

  • Ability to contribute to discussions on general management strategies in order to understand all the considerations on which treatment to use and which sequence to select for the multidisciplinary strategy

  • Ability to prescribe various chemotherapeutic and targeted agents as well as monoclonal antibodies

  • Ability to recognise conditions (such as performance status and patients’ clinical condition, concomitant disease(s), previous treatments etc) that are important for considering when to start and to stop treatment or to switch to another option

  • Ability to determine therapy according to molecular marker status

  • Ability to manage side effects of various chemotherapeutic, targeted agents and monoclonal antibodies

  • Ability to discuss chemoprevention strategies with patients

  • Ability to discuss genetic counselling/testing with patients and their relatives

  • Ability to discuss survivorship and compliance issues (particularly regarding adjuvant endocrine therapy) with patients

  • Ability to discuss and advise fertility preservation