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Q1: DCIS Management (3 min)
"How do you manage screen-detected DCIS?"
- Core biopsy for histology + grade + ER/PR/HER2
- WLE with clear margins (at least 2 mm) + whole-breast RT
- Tamoxifen for ER-positive DCIS (5 years)
- Mastectomy for large/multicentric/high-grade
- VNPI guides treatment intensity
Q2: Margin Status (2 min)
"Why are margins important in DCIS?"
- Margin status is the strongest predictor of local recurrence
- Need at least 2 mm clear margin
- If positive: re-excision or mastectomy
- RT reduces recurrence by 50% but cannot compensate for positive margins
Q3: Tamoxifen (3 min)
"What is the role of tamoxifen in DCIS?"
- Only for ER-positive DCIS
- NSABP B-24 trial: 50% reduction in ipsilateral and contralateral breast events
- Duration: 5 years
- Side effects: VTE, endometrial cancer, hot flushes
- Alternatives for post-menopausal: aromatase inhibitors (anastrozole)