# Breast Cancer, Version 4.2026, NCCN Clinical Practice Guidelines In Oncology

Source: https://onco.cc/key-papers/paper-nccn-breast-cancer-v4-2026-jnccn-2026/  
OnCo record `paper-nccn-breast-cancer-v4-2026-jnccn-2026` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2026 journal summary of the US NCCN breast cancer guideline, this version focused on recurrent and metastatic disease and how treatment is chosen by receptor status, prior therapy and time since treatment.

## Summary

Journal summary of the NCCN Clinical Practice Guidelines for Breast Cancer, version 4.2026, by Gradishar, Moran, Abraham, Abramson and colleagues. The guidelines cover carcinoma in situ, invasive breast cancer, Paget's disease, phyllodes tumour, inflammatory breast cancer and breast cancer in pregnancy; the panel convenes annually. This selection concentrates on recurrent or stage IV (M1) disease and summarises treatment stratified by hormone receptor status and HER2 expression, prior therapy and disease-free interval, with supportive care, quality of life, toxicity minimisation and trial participation emphasised throughout. The NCCN category grades quoted on the triple-negative page (category 1, preferred for the KEYNOTE-522 regimen and for first-line sacituzumab govitecan with pembrolizumab) come from the full guideline.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Journal of the National Comprehensive Cancer Network
- Year: 2026
- DOI: 10.6004/jnccn.2026.0033
- Authors: Gradishar WJ, Moran MS, Abraham J, et al.
- Findings: This version's text concentrates on recurrent or stage IV (M1) disease stratified by hormone receptor and HER2 status, prior therapy and disease-free interval.; Supportive care, quality of life, toxicity minimisation and trial participation are emphasised across all treatment lines.
- What it means: NCCN is the source of the category grades on the triple-negative breast cancer page and the first major guideline to place an antibody-drug conjugate first line for the disease.
- Caveats: The full guideline requires free registration on nccn.org; the JNCCN article is a summary.; US practice and payer context; not all listed options are funded in the UK.

## Sources

- JNCCN 2026: https://doi.org/10.6004/jnccn.2026.0033
- PubMed: https://pubmed.ncbi.nlm.nih.gov/42425164/
- NCCN Guidelines: Breast Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1419

## Connected records

- collections: [NCCN Guidelines](https://onco.cc/collections/nccn/)
- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- trials: [ASCENT-03](https://onco.cc/trials/ascent-03/), [ASCENT-04 / KEYNOTE-D19](https://onco.cc/trials/ascent-04/), [KEYNOTE-522](https://onco.cc/trials/keynote-522/), [TROPION-Breast02](https://onco.cc/trials/tropion-breast02/)
- journals: [Journal of the National Comprehensive Cancer Network](https://onco.cc/journals/jnccn/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)

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