A 56-year-old woman undergoes wide local excision with clear margins for a 14 mm high grade comedo-type ductal carcinoma in situ detected on screening mammography. Sentinel lymph node biopsy was negative. What is the most appropriate adjuvant treatment?

• A Adjuvant chemotherapy with anthracycline and taxane
• B Adjuvant trastuzumab for one year
• C No further treatment other than annual mammography
• D Whole breast radiotherapy, with consideration of tamoxifen ✓

Explanation

After breast conserving surgery for pure DCIS, whole breast radiotherapy roughly halves the risk of local recurrence including invasive events, as shown in NSABP B-17, and endocrine therapy with tamoxifen may further reduce events in ER-positive disease. Chemotherapy and trastuzumab have no role in DCIS because there is no invasive component, eliminating A and B. Omitting radiotherapy leaves a substantial recurrence rate even with clear margins.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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