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Course Description

Through case presentations illustrating two scenarios for follow-up discussion, this course will provide up-to-date management and treatment decisions about recommendations for risk reduction and risk assessment, imaging, surgery, radiation therapy and chemotherapy. Key topics will be management for atypical lesions, when surgery can be avoided, and what mutations are actionable and is enhanced surveillance. Newest guidelines using 3D mammography, when ultrasound is indicated, work-up of calcifications and masses, and when MRI is indicated will be covered. The use of SaviScout versus wire localization will be reviewed. Discussions include "stretching" indications for lumpectomy with oncoplastic technique where mastectomy at first glance may be the preferred option and most up-to-date guideline for margins for ductal carcinoma in situ and invasive cancer (DCIS). The second case will focus on nipple sparing mastectomy and oncoplastic safety and techniques. Cases will be presented in real time and chosen to reflect the changing landscape of current recommendations in each of these fields.

Educational Objectives

After participating in this activity, clinicians should be able to:

1. Describe the high risk guidelines from the ASBrS (American Society of Breast Surgeons) and identify which pathologic lesions on needle biopsies warrant referral to a breast surgeon for surgical management and how to counsel their patients regarding treatment and follow up
2. Describe what are the high risk mutations and which are moderate risk mutations from the NCCN (National Comprehensive Cancer Network)
3. Recognize who can have partial breast irradiation and who needs whole breast radiation and when a boost is indicated according to American Society of Radiation Oncology (ASTRO)
4. Determine if additional radiation is feasible, by looking at time to recurrence, tumor characteristics, nodal status and age of patient
5. Recognize when is it reasonable to consider doing lumpectomy with oncoplastic closure and implications it has on radiation techniques

Target Audience

Primary care physicians, gynecologists, general surgeons, registered nurses, advanced practice providers, dietitians, psychologists, medical students, nursing students, residents, fellows and all interested clinicians.