Early-stage (non-metastatic) breast cancer: clinical or pathological stage I, II, or III....

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-BREAST-EARLY-STAGE`
Type	Red flag
Status	reviewed 2026-05-08 \| pending_clinical_signoff
Diseases	`DIS-BREAST`
Sources	`SRC-NCCN-BREAST-2025`

Red Flag Origin

Definition	Early-stage (non-metastatic) breast cancer: clinical or pathological stage I, II, or III. Defined by absence of distant metastasis (M0 per TNM 8th edition). Early-stage breast cancer is potentially curable with locoregional and systemic therapy; the treatment intent is curative, not palliative. Early stage is the gating criterion for neoadjuvant (pre-operative) or adjuvant (post-operative) systemic therapy rather than palliative 1L metastatic regimens. Neoadjuvant therapy (TCHP for HER2+; pembro+chemo for TNBC KEYNOTE-522; endocrine ± CDK4/6i for HR+) is preferred for stage II-III tumors. Stage I HR+ tumors may receive adjuvant endocrine therapy without neoadjuvant chemotherapy. Fires to route ALGO-BREAST-1L step 2 (HER2+ branch) to neoadjuvant therapy (IND-BREAST-HER2-POS-EARLY-NEOADJUVANT) rather than metastatic 1L (IND-BREAST-HER2-POS-MET-1L-THP).
Clinical direction	intensify
Category	other
Shifts algorithm	ALGO-BREAST-1L

Trigger Logic

{
  "all_of": [
    {
      "any_of": [
        {
          "finding": "stage_group",
          "value": "I"
        },
        {
          "finding": "stage_group",
          "value": "IA"
        },
        {
          "finding": "stage_group",
          "value": "IB"
        },
        {
          "finding": "stage_group",
          "value": "II"
        },
        {
          "finding": "stage_group",
          "value": "IIA"
        },
        {
          "finding": "stage_group",
          "value": "IIB"
        },
        {
          "finding": "stage_group",
          "value": "III"
        },
        {
          "finding": "stage_group",
          "value": "IIIA"
        },
        {
          "finding": "stage_group",
          "value": "IIIB"
        },
        {
          "finding": "stage_group",
          "value": "IIIC"
        },
        {
          "finding": "stage_group",
          "value": "early"
        },
        {
          "finding": "disease_extent",
          "value": "localized"
        },
        {
          "finding": "disease_extent",
          "value": "locally_advanced"
        }
      ]
    },
    {
      "any_of": [
        {
          "finding": "stage_group",
          "value_not": "IV"
        },
        {
          "finding": "distant_metastasis",
          "value": false
        },
        {
          "finding": "m_stage",
          "value": "M0"
        }
      ]
    }
  ],
  "type": "stage_classification"
}

Notes

W5c RF authoring. Converts free-text `{condition: "Stage I-III (early)"}` in ALGO-BREAST-1L step 2 (HER2+ branch) into a formal RF entity. The trigger uses a positive stage group match (I/II/III with substages) combined with a negative M0 check. The `any_of: [stage_group: "I"...]` covers TNM 8th-edition staging codes; the `any_of: [stage_group ≠ "IV", distant_metastasis: false]` adds belt-and-suspenders exclusion of M1. Note: The `value_not` field is non-standard — the engine team should confirm whether this negation syntax is supported. If not, use the positive stage_group values as the sole trigger (stages I, II, III) without the M0 negation check. The M0 confirmation is belt-and-suspenders. ALGO-BREAST-1L step 2 routes: if_true (RF fires = early stage): IND-BREAST-HER2-POS-EARLY-NEOADJUVANT if_false (RF doesn't fire = metastatic/unknown): IND-BREAST-HER2-POS-MET-1L-THP CHARTER §6.1: Two-reviewer clinical co-lead signoff required before removing draft: true.

Used By

Algorithms

ALGO-BREAST-1L - ALGO-BREAST-1L