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Competing Interests: Disclosure CS has reported non-remunerated activities as Coordinator Gynecological Programme for the European School of Oncology. JB has reported fees for advisory board membership for AstraZeneca and Pfizer; fees paid to her institute for roles as local principal investigator for AstraZeneca, MedSire and Pfizer. SLB has reported fees as an author for UpToDate. She has also reported non-remunerated activities as the chair of the Scientific Network on Female Sexual Health and Cancer (academic organisation). MJC has reported fees as an invited speaker for Roche (industry-sponsored symposium in National Conference). She has also reported non-remunerated activities as a member of the Board of Directors of EUSOMA, faculty member of ESO, project lead/lead investigator for the Breast Research Group of INESC TEC and President of MAMA Help (non-profit association for breast cancer patients in Portugal). She serves as a Specialty Editor for The Breast. NC has reported fees for advisory board membership for AstraZeneca, BIOCAD, Clovis Oncology, Eisai, GlaxoSmithKline (GSK), ImmunoGen, Mersana, Merck Sharp & Dohme (MSD)/Merck, Nuvation Bio, OncXerna, Pfizer, PharmaMar, Pieris and Roche; fees as an invited speaker for AstraZeneca, Clovis Oncology, GSK and MSD/Merck; institutional research grants from AstraZeneca, PharmaMar and Roche. She has also reported non-remunerated activities as member of the ESMO Guidelines Steering Committee and chair of the Scientific Committee of Alleanza contro il Tumore Ovarico (ACTO). GC has reported fees for advisory board membership for AstraZeneca, Bristol Myers Squibb (BMS), Celcuity, Daiichi Sankyo, Ellipsis, Exact Sciences, Lilly, Merck, Pfizer, Roche and Veracyte; fees as an invited speaker for AstraZeneca, Daiichi Sankyo, Novartis, Pfizer and Roche; fees for a writing engagement from Pfizer; institutional research grant from Merck for an investigator-initiated trial; institutional funding for phase I studies from Astellas, AstraZeneca, Blueprint Medicine, BMS, Daiichi Sankyo, Kymab, Novartis, Philogen, Relay Therapeutics, (coordinating principal investigator), Roche and Sanofi. He has also reported non-remunerated activities as an Italian National Health Council as Advisor for Ministry of Health (Consiglio Superiore di Sanità), member of the Scientific Council for the patient advocacy association Europa Donna, advisory role at the Fondazione Beretta cancer research foundation, member of the Board of Directors for Lega Italian Lotta ai Tumori (public national company for cancer prevention) and member of the Advisory Council of EUSOMA. SMD has reported personal honoraria from AstraZeneca, BMS and Clovis; fees paid to her institute as coordinating principal investigator for AstraZeneca. DGE has reported fees for advisory board membership for Recursion, SpringWorks and Syantra; consultancy fees for a writing engagement for AstraZeneca. DF has declared no conflicts of interest. NH has reported fees for advisory board membership for Aptitude Health, AstraZeneca, Daiichi Sankyo, Gilead, Novartis, Pfizer, Roche, Sandoz-Hexal, Sanofi and SeaGen; fees as an invited speaker for Art Tempi, AstraZeneca, Daiichi Sankyo, Exact Sciences, Gilead, Lilly, Medscape, MSD, Novartis, Onkowissen, Pierre Fabre, Roche, Sanofi and SeaGen; institutional funding from AstraZeneca, BMS, Daiichi Sankyo, Lilly, MSD, Novartis, Palleos, Pierre Fabre, Roche, SeaGen, TRIO and WSG; ownership interest in the West German Study Group. She has also reported non-remunerated activities as a member of the AGO Breast Guideline Committee and member of the ESO/ESCO Breast Cancer Educational Programs. She is the Founding Editor of the Breast Care journal. CK has reported fees for advisory board membership for Guerbet; fees as an invited speaker for Bayer and Bracco. BL has reported fees received from the Rising Tide Foundation as a patient reviewer. She has also reported non-remunerated activities as a member of the European Society of Gynaecological Oncology (ESGO) ENGAGe (Past Executive Board Member) and chair of KIU—Danish Patient Organisation for Women with Gynaecological Cancer. ELL has reported employment as the Director of the Medical Genetics Institute of the Shaare Zedek Medical Center. She has also reported non-remunerated activity as the vice president of the Israel National Academy of Science in Medicine (non-profit). ML has reported fees for advisory board membership and speaker fees for AstraZeneca, Exact Sciences, Gilead, Lilly, MSD, Novartis, Roche and SeaGen; fees as an invited speaker for Ipsen, Knight, Libbs, Pfizer, Sandoz, SeaGen and Takeda. JAL has reported fees for advisory board membership for Artios Pharma, AstraZeneca, BMS, Clovis Oncology, Eisai, Ellipses, GSK, ImmunoGen, Merck/MSD, Nuvation, Pfizer and VBL Therapeutics; speaker fees from AstraZeneca, Clovis Oncology, GSK and Neopharm; fees related to an independent data monitoring committee for Regeneron; institutional research grants from AstraZeneca, Clovis Oncology, Eisai, GSK, MSD/Merck and Pfizer. He has also reported non-remunerated activities as vice president of the European Society of Gynaecological Oncology (2019-2021). He serves as an associate editor of Therapeutic Advances in Medical Oncology (Sage Publishing). SL has reported fees paid to her institute for advisory board membership for AbbVie, Amgen, AstraZeneca, BMS, Celgene, DSI, EirGenix, Gilead, GSK, Lilly, Merck, Novartis, Pfizer, Pierre Fabre, Relay Therapeutics, Roche, Sanofi and SeaGen; fees paid to her institute as an invited speaker for AstraZeneca, DSI, Gilead, Novartis, Pfizer and Roche; employment as the Chief Executive officer (CEO) of GBG Forschungs GmbH; licensing fees paid to her institute by VM Scope GmbH; research grants to her institute from AstraZeneca, Celgene, Daiichi Sankyo, Immunomedics/Gilead, Novartis, Pfizer and Roche; institutional funding from AbbVie and Molecular Health; fees paid to her institute as principal investigator (Penelope/Padma) from Pfizer; fees paid to her institute from AstraZeneca (SC Capitello), Daiichi Sankyo (SC Destiny B05), Immunomedics/Gilead (SC ASCENT), Novartis (SC SOLAR1), Pfizer (SC PALOMA3), Roche (SC Inavo and SC Katherine), SeaGen (SC HERCLIMB). She has also reported non-remunerated activities as principal investigator for Aphinity, advisory role to Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Kommission Mamma (group in Germany responsible for breast cancer guidelines), membership of AGO, Deutsche Krebsgesellschaft (DKG), American Society of Clinical Oncology (ASCO) and ESMO including membership of the ESMO Guidelines Committee and past chair of the ESMO Breast Congress. She has reported institutional patents for which she has no financial interests: EP14153692.0, EP21152186.9, EP15702464.7, EP19808852.8. K-AP has reported non-remunerated activities as advisory board member for AstraZeneca, Scientific Advisory Committee member for Breast Cancer Trials, project lead in Australia for the DECRESENDO and OlympiA studies, member of the Expert Advisory Group on Cancer Clusters for the Victorian Department of Health and Human Services, Strategic Advisory Committee member for Breast Cancer Network Australia, Cancer Genetics Reference Committee Member for New South Wales Cancer Institute; advisory role on the register of experts for breast and hereditary cancer for the Medical Oncology Group of Australia and breast cancer optimal care pathway committee member for Cancer Council Victoria. She is also a leadership fellow of the National Health and Medical Research Council (Australia) and a practitioner fellow of the National Breast Cancer Foundation (Australia). SP-S has reported fees paid to her institute for advisory board membership for AstraZeneca, Eli Lilly, Exact Sciences, Medison, Pfizer and Roche; fees paid to her institute as an invited speaker for AstraZeneca, Eli Lilly, Exact Sciences, Medison, Novartis, Pfizer and Roche; fees paid to her institute for consultancy for Medison; personal and institutional research grant for an request for proposal for independent research put out by Shared Progress in Cancer Care and Pfizer.

We dedicate this manuscript in memory of a dear friend and colleague Bella Kaufman. The fifth International Consensus Symposium for Breast Cancer in Young Women (BCY5) took place virtually in October 2020, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY4 with incorporation of new evidence to inform the guidelines. Areas of research priorities as well as specificities in different geographic and minority populations were identified. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA)., Competing Interests: Disclosure SPS: Advisory Board consultancy, speaker's bureau: AstraZeneca, Pfizer, Novartis, Lilly, Roche, MSD, Exact Sciences. Research Funding: Pfizer. HAA: Recipient of grants/research supports: Amgen. Recipient of honoraria or consultation fees: Novartis, Roche. Employment: Pierre Fabre. FC: Recipient of honoraria or consultation fees: Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi-Sankyo, Eisai, GE Oncology, Genentech, GlaxoSmithKline, Macrogenics, Medscape, Merck-Sharp, Merus BV, Mylan, Mundipharma, Novartis, Pfizer, Pierre-Fabre, prIME Oncology, Roche, Samsung Bioepis. GC: Recipient of grants/research supports: Merck, Astra Zeneca. Recipient of honoraria or consultation fees: Daichii Sankyo. Participation in a sponsored speakers’ bureau: Novartis, Pfizer, Lilly. KAG: Recipient of grants/research supports: Pfizer, Astra Zeneca. Recipient of honoraria or consultation fees: Pfizer, Lilly, Astrazeneca, Novartis, Mylan, Benentech, Merck, Roche, Nanostring. NH: Honoraria for lectures and/or consulting from Amgen, Astra Zeneca, Daiichi-Sankyo, Exact Sciences, Lilly, MSD, Novartis, Pierre Fabre, Pfizer, Roche, Sandoz, Seagen (all outside the submitted work). SBK: Research funding from Novartis, Sanofi-Aventis and DongKook Pharm Co; consultant in advisory boards—Novartis, AstraZeneca, Lilly, Dae Hwa Pharmaceutical Co. Ltd, ISU Abxis, Daiichi-Sankyo and Beigene; and stocks—Genopeaks, NeogeneTC (all outside the submitted work). FP: Recipient of honoraria or consultation fees: Roche Diagnostics, Ipsen, Merck (all outside the submitted work). ES: Recipient of grants/research supports: Amgen, AstraZeneca, Boehringer, Eli Lilly, Merck, Novartis, Pfizer, Roche, Samsung. Recipient of honoraria or consultation fees: Amgen, AstraZeneca, Clinigen, Egis, Eli Lilly, Genomic Health, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz, TLC Biopharmaceuticals. Travel support: Amgen, AstraZeneca, Egis, Novartis, Pfizer, Roche. All other authors have declared no conflicts of interest., (Copyright © 2022 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.)

Competing Interests: Disclosure MSA reports receipt of consultation fees from Amgen, BMS, Celgene, Clinigen, Eisai, Genomic Health, GSK, Helsinn, Hospira, JnJ, Novartis, Merck, Merck Serono, Mundipharma, Pfizer, Pierre Fabre, Roche, Sandoz, Tesaro, Tevam Vifor, G1 Therapeutics and Lilly; receipt of honoraria for symposia lectures from Amgen, Bayer, Schering, Cephalon, Chugai, Eisai, Genomic Health, GSK, Helsinn, Hospira, Ipsen, JnJ Ortho Biotech, Kyowa Hakko Kirin, Merck, Merck Serono, Mundipharma, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz, Sanofi, Tesaro, Taiho, Tevam Vifor, G1 Therapeutics and Lilly. CHB reports receipt of honoraria or consultation fees from Boehringer Ingelheim, GSK, Novartis, Pfizer, Roche/Genentech, Eisai, MSD, AstraZeneca and Bayer; receipt of grants/research support to the institution from AbbVie, Amgen, Astellas Pharma, AstraZeneca, BMS, Celgene, Covance, Lilly, Medivation, Merck Serono, MSD, Novartis, Pfizer, PharmaMar and Roche/Genentech. JB reports receipt of grants/research support grants to Karolinska Institute and University Hospital from Amgen, AstraZeneca, Bayer, Merck, Pfizer, Roche, Sanofi-Aventis; no personal payments; payment from UpToDate to Asklepios Medicine HB for a chapter on breast cancer prediction. LB reports receipt of grants/research support from Celgene, Genomic Health and Novartis; receipt of honoraria or consultation fees from AstraZeneca, Celgene, Daiichi Sankyo, Eisai, Genomic Health, Ipsen, Lilly, Novartis, Pfizer, Pierre Fabre and Roche. FC reports receipt of honoraria or consultation fees from Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi Sankyo, Eisai, GE Oncology, Genentech, GSK, MacroGenics, Medscape, MSD, Merus BV, Mylan, Mundipharma, Novartis, Pfizer, Pierre Fabre, prIME Oncology, Roche, Sanofi, Seattle Genetics and Teva. JC reports acting as a consultant/advisor for Roche, Celgene, Cellestia, AstraZeneca, Biothera Pharmaceutical, Merus, Seattle Genetics, Daiichi Sankyo, Erytech, Athenex, Polyphor, Lilly, Servier, MSD, GSK, Leuko, Bioasis, Clovis Oncology, Boehringer Ingelheim and Kyowa Kirin; received honoraria from Roche, Novartis, Celgene, Eisai, Pfizer, Samsung Bioepis, Lilly, MSD and Daiichi Sankyo; received research funding to the institution from Roche, Ariad Pharmaceuticals, AstraZeneca, Baxalta GMBH/Servier Affaires, Bayer Healthcare, Eisai, F. Hoffmann-La Roche, Guardant Health, MSD, Pfizer, PIQUR Therapeutics, Puma C and Queen Mary University of London; holds stock, patents and intellectual property for MEDSIR; received travel, accommodation and expenses from Roche, Novartis, Eisai, Pfizer and Daiichi Sankyo. GC reports receipt of honoraria or consultation fees from Roche, Pfizer, Lilly, Novartis and SeaGen; participation in a sponsored speakers' bureau for SeaGen, Pfizer, Lilly and Novartis. NSES reports receipt of grants/research support to institution from Novartis; receipt of honoraria or consultation fees from Novartis, Roche, Pfizer, Lilly and AstraZeneca. ME reports acting in an advisory role for Novartis and Roche. AE reports receipt of grants/research support from AstraZeneca, Roche, Celltrion, Pfizer and Novartis. LF reports receipt of grants/research support from BMS, GSK, Myriad and Novartis; receipt of honoraria or consultation fees from BMS, AstraZeneca, Teva, Novartis, Eisai, Takeda, Pfizer, Lilly, Genomic Health and Myriad. PAF reports receipt of honoraria or consultation fees from AstraZeneca and Novartis; travel for lecture for Pfizer and Ipsen. KG reports receipt of grants/research support from AstraZeneca, Pfizer and BMS; receipt of honoraria or consultation fees from Pfizer, AstraZeneca, Novartis, Nanostring, Merck, Mylan, Genomic Health, Roche and BMS. JG reports receipt of grants/research support from Amgen, Eisai, Genomic Health, Novartis, Pfizer and Roche/Genentech; receipt of honoraria or consultation fees from Daiichi, Eisai, Genomic Health, Ipsen, MacroGenics, MSD, Mylan, Novartis, Onxeo, Pfizer and Roche/Genentech; participation in a sponsored speakers' bureau for Eisai, Genomic Health, Ipsen, Novartis, Pfizer and Roche/Genentech. NH reports receipt of honoraria or consultation fees from Amgen, AstraZeneca, Celgene, Daiichi Sakyo, Lilly, MSD, Novartis, Odonate, Pfizer, Roche, Sandoz/Hexal and Seattle Genetics. RK reports receipt of grants/research support from Pfizer Malaysia. BEK reports receipt of grants/research support to institution from Roche; receipt of honoraria for advisory boards and educational presentations as well as travel and meeting expenses from Roche; receipt of honoraria for advisory boards and educational presentations from Novartis. SBK reports receipt of grants/research support to institution from Novartis, Sanofi-Aventis, Kyowa Kirin Inc. and DongKook Pharm Co.; receipt of consultancy fees from Novartis, AstraZeneca, Lilly, Enzychem, Daehwa Pharmaceutical Co. Ltd, ISU ABXIS and Daiichi Sankyo. NUL reports receipt of grants/research support from Genentech and Seattle Genetics; receipt of honoraria or consultation fees from Seattle Genetics, Daiichi Sankyo and Puma. SAM reports receipt of honoraria from Pfizer and Lilly; SN reports receipt of grants/research support from Roche, Pfizer, BMS and Novartis; participation in a sponsored speakers' bureau for Roche, Pfizer, BMS, Merck and Novartis. LN reports receipt of honoraria from Sermonix Oncology Ad Board, Prime Oncology, Sarah Lawrence Lecture, Context advisory board, Oncology Pioneers Science Lecture Series, BCRF programmatic review meeting and CSHL external advisory board meeting. SO reports receipt of grants/research support from Chugai, Eisai, Taiho, Daiichi Sankyo; participation in a sponsored speakers' bureau for Chugai, AstraZeneca, Eisai, Taiho, Pfizer and Lilly. OP reports participation in a sponsored speakers' bureau for Takeda, Roche, Pfizer, Novartis and Lilly. SPS has participated in a speakers' bureau and received honoraria from Roche, AstraZeneca, Novartis, Pfizer, Nanostring and Teva; reports consultancy for Roche, AstraZeneca, Novartis and Pfizer. FPL reports receipt of grants/research support from Roche; receipt of honoraria or consultation fees from Roche, Puma, Pierre Fabre and AstraZeneca. AP reports personal financial interests and lecture fees for Roche, Pfizer, Novartis, Amgen, BMS and Daiichi Sankyo; participation in an advisory role/consultancy for Roche, Pfizer, Novartis, Amgen, BMS, Puma and Oncolytics Biotech; institutional financial interests include contracted research for Novartis, Nanostring, Roche and Boehringer; lecture fees from Nanostring technologies; clinical trials for Novartis, Roche, Boehringer, Daiichi Sankyo, Pfizer, Lilly and Amgen. HSR reports receipt of grants/research support from Pfizer, Merck, Novartis, Lilly, Genentech, OBI, Odonate, Daiichi Sankyo, Eisai, Seattle Genetics, MacroGenics and Immunomedics. ES reports receipt of honoraria or consultation fees from Amgen, AstraZeneca, Clinigen, Egis, Eli Lilly, Genomic Health, Novartis, Pfizer, Pierre Fabre, Roche, Sandoz and TLC Biopharmaceuticals; travel support from Amgen, AstraZeneca, Egis, Novartis, Pfizer and Roche; contracted research for Amgen, AstraZeneca, Boehringer, Eli Lilly, Merck, Novartis, Pfizer, Roche and Samsung; holds stock in Eli Lilly. EPW reports receipt of grants/research support from Merck and Genentech/Roche; receipt of honoraria or consultation fees from Carrick Therapeutics, Genentech/Roche, Genomic Health, GSK, Jounce, Leap, Lilly, Merck and Seattle Genetics; research fees to institute from Genentech/Roche and Merck; participation in a scientific advisory board for Leap. BX reports receipt of advisory fees from Novartis and Roche; fees for serving on a speakers' bureau from AstraZeneca, Pfizer, Roche and Eisai. FA, FB, BK, FEL, GWS, CT and TW have not reported any potential conflict of interest. GSB, MJC, LAC, AC, RH, XH, BVO and DAV have declared no significant conflict of interest.

The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were also identified. This article summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA)., Competing Interests: Disclosure For a full list of all members of the BCY4 consensus panel and their disclosure of any potential conflicts of interest, see supplementary Table S1, available at Annals of Oncology online., (Copyright © 2020 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.)

Background: Using surrogate end points for overall survival, such as disease-free survival, is increasingly common in randomized controlled trials. However, the definitions of several of these time-to-event (TTE) end points are imprecisely which limits interpretation and cross-trial comparisons. The estimation of treatment effects may be directly affected by the definitions of end points. The DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials) aims to provide recommendations for definitions of TTE end points. We report guidelines for randomized cancer clinical trials (RCTs) in breast cancer., Patients and Methods: A literature review was carried out to identify TTE end points (primary or secondary) reported in publications of randomized trials or guidelines. An international multidisciplinary panel of experts proposed recommendations for the definitions of these end points based on a validated consensus method that formalize the degree of agreement among experts., Results: Recommended guidelines for the definitions of TTE end points commonly used in RCTs for breast cancer are provided for non-metastatic and metastatic settings., Conclusion: The use of standardized definitions should facilitate comparisons of trial results and improve the quality of trial design and reporting. These guidelines could be of particular interest to those involved in the design, conducting, reporting, or assessment of RCT., (© The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: In breast cancer treated with breast-conserving radiotherapy, the influence of the boost dose on cosmetic outcome after long-term follow-up is unknown., Patients and Methods: We included 348 patients participating in the EORTC 'boost versus no boost' mega trial with a minimum follow-up of 6 years. Digitalised pictures were analysed using specific software, enabling quantification of seven relative asymmetry features associated with different aspects of fibrosis., Results: After 3 years, we noted a statistically significantly poorer outcome for the boost patients for six features compared with those of the no boost patients. Up to 9 years of follow-up, results continued to worsen in the same magnitude for the both patient groups. We noted the following determinants for poorer outcome: (i) boost treatment, (ii) larger excision volumes, (iii) younger age, (iv) tumours located in the central lower quadrants of the breast and (v) a boost dose administered with photons., Conclusions: A boost dose worsens the change in breast appearance in the first 3 years. Moreover, the development of fibrosis associated with whole-breast irradiation, as estimated with the relative asymmetry features, is an ongoing process until (at least) 9 years after irradiation.