Breast Cancer — Viva

Q1: Triple assessment (2 min)

• Clinical + mammogram/US + core biopsy with receptors
• Concordance ~98%; never reassure on exam alone

Q2: Molecular subtypes drive therapy (3 min)

• ER/PR+ endocrine; HER2+ trastuzumab ± pertuzumab; TNBC chemo ± immuno pathways
• State tamoxifen 20 mg OD vs AI doses; trastuzumab 8 then 6 mg/kg q3w × 1 y + LVEF [1]

Q3: BCS vs mastectomy (2 min)

• Equivalent survival with RT after BCS; margins; cosmesis; patient choice
• RT reduces local recurrence (EBCTCG principles)

Q4: Axilla (2 min)

• SLNB for cN0; ALND selective; Z0011 de-escalation concept for low burden + BCS+RT era
• Lymphoedema counselling mandatory

Q5: Inflammatory & Paget (3 min)

• IBC T4d: neoadjuvant first, not endless antibiotics
• Paget: unilateral nipple eczema — image and biopsy underlying disease

Q6: Male & BRCA (2 min)

• Male: mastectomy + tamoxifen; genetic testing
• BRCA: MRI surveillance, risk-reducing surgery options after counselling

Q7: Metastatic bone (2 min)

• Zoledronic acid 4 mg IV or denosumab 120 mg SC q4w; RT; orthopaedic fixation of impending fracture [1]

Q8: DCIS (2 min)

• Non-invasive, cannot metastasise; microcalcifications; WLE+RT or mastectomy; axilla usually not for pure DCIS

Q9: Screening principles (2 min)

• Mammography age bands vary by region; India often CBE + awareness given younger presentation/dense breasts
• Screening detects DCIS and earlier invasive disease

Q10: Neoadjuvant indications (2 min)

• Locally advanced, inflammatory, HER2+/TNBC downstaging for BCS, in-vivo response assessment

Q11: Follow-up (2 min)

• Clinical exam + annual mammography; endocrine adherence; bone health on AI; cardiotoxicity surveillance after HER2/anthracycline

Q12: Breaking bad news structure (1 min)

• Warning shot, plain language, pause, agenda, support, MDT next steps, written info

References7Show ledgerHide ledger

1. [1]Leon-Ferre RA, Goetz MP. Advances in systemic therapies for triple negative breast cancer BMJ, 2023.PMID 37253507
2. [2]Hassett MJ, Somerfield MR, Baker ER, et al. Management of Male Breast Cancer: ASCO Guideline J Clin Oncol, 2020.PMID 32058842
3. [3]Waks AG, Winer EP. Breast Cancer Treatment: A Review JAMA, 2019.PMID 30667505
4. [4]Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials Lancet, 2011.PMID 22019144
5. [5]Modi S, Jacot W, Yamashita T, et al. Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer N Engl J Med, 2022.PMID 35665782
6. [6]Robson M, Im SA, Senkus E, et al. Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation N Engl J Med, 2017.PMID 28578601
7. [7]Taylor C, Correa C, Duane FK, et al. Estimating the Risks of Breast Cancer Radiotherapy: Evidence From Modern Radiation Doses to the Lungs and Heart and From Previous Randomized Trials J Clin Oncol, 2017.PMID 28319436