The Utility of the KBCS Guidelines tions but the margins were positive when permanent sections were examined, about 50% of physicians perform secondary operations to guarantee negative margins. In addition, approxi- mately 30% of physicians at least consider scheduling a sec- ondary operation, depending on the number and extent of positive marginal lesions. However, about 20% eschew further axillary procedures. Sentinel lymph node biopsy (SLNB) is generally not recom- mended for patients with simple DCIS but is recommended for select patients treated with mastectomy or excision in an anatomic setting which may compromise the performance of any future sentinel lymph node procedure [7,8]. About 60% of respondents selectively perform SLNB in DCIS patients, and about 40% do not require that any clinical precondition should be met. DIAGNOSIS Eighty percent of physicians performed breast magnetic resonance imaging (MRI) in EBC patients, whereas the pro- portion was 94% for metastatic breast cancer (MBC) patients. In EBC patients, 26% of physicians always perform a breast MRI, without any clinical precondition, but 20% never order an MRI under any clinical circumstance. However, for MBC patients, 37% of physicians always perform breast MRI, with- out any clinical precondition, whereas 6% never order the test under any clinical circumstance. The NCCN guidelines rec- ommend that breast MRI should serve as an optional add- itional modality for evaluation of the extent of ipsilateral dis- ease, and to screen the contralateral breast, particularly in women at increased risk for mammographically occult dis- ease (both EBC and MBC) [9,10]. Most respondents (85%) conduct tumor estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) determination on preoperative biopsy samples, and the principal methods of HER2 testing are immu- nohistochemistry (IHC) stain and fluorescence in situ hybrid- ization (FISH). These practices almost meet the NCCN recom- mendations. Chromogenic in situ hybridization (CISH) is a relatively new method for the detection of gene amplification via a peroxidase reaction, with the results obtained using a stan- dard light microscope [11]. CISH, as a HER2 test, is performed by about 9% of survey respondents. Current studies have re- vealed that the concordance rate between CISH and FISH data is high, and that the CISH test is very accurate. We expect that CISH may be a valuable option in terms of HER2 testing, but no DNA probe kit is yet available in the United States. 241 CHEMOTHERAPY Our questions exploring the chosen chemotherapy regimens for EBC patients focused on nodal and ER/PR status. In node- negative patients, some differences between the choice of chemotherapy regimen for ER-positive and -negative patients were evident. Four cycles of adriamycin+cyclophosphamide (AC) are preferred for ER-positive patients, but six cycles of 5-fluorouracil+adriamycin+cyclophosphamide (FAC) for ER- negative patients, among those who are node-negative. In the node-positive group, no difference in terms of ER positivity were evident, and the preferred regimen is four cycles of AC followed by four cycles of paclitaxel. However, six cycles of adriamycin+docetaxel (AT) or epirubicin+docetaxel (ET) are preferred when neoadjuvant chemotherapy is used to treat patients with locally advanced breast cancer. TRASTUZUMAB THERAPY The evaluation methods appropriate to and the proper inter- vals for assessment of trastuzumab-induced cardiac toxicity during and after trastuzumab therapy remain unclear. Our survey data reveal inconsistencies in the clinical modes by which respondents screen for trastuzumab-induced cardiac toxicity. However, in general, tests are conducted at 3 to 6 months intervals, and employ echocardiography; the screen- ing is accepted as appropriate [12]. ENDOCRINE THERAPY We asked our respondents to report on the use of hormonal therapy in patients with locally advanced breast cancer. Most physicians preferred 2 years of treatment with a GnRH agonist concurrent with 5 years of tamoxifen in premenopausal women or 5 years of aromatase inhibitor therapy in postmenopausal women. A minority of physicians preferred 5 years of tamoxi- fen for premenopausal women. These data seem to reflect the generally accepted consensus of the utility of hormonal ther- apy to treat those with local breast cancer. A related study has been performed in Korea; this is the ASTRRA trial (encoded KBCSG005) which evaluated the utility of the addition of ovar- ian function suppression therapy to tamoxifen use in young women ( ≤ 45 years of age) with hormone-sensitive breast can- cer who remained in a premenopausal state or who resumed menstruation after chemotherapy. The results of this trial may facilitate optimal decision-making in terms of hormonal ther- apy for premenopausal women with breast cancer. http://dx.doi.org/10.4048/jbc.2012.15.2.239 http://ejbc.kr