Ductal carcinoma in situ: the decisions you may face

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between IMRT / IGRT (modern external beam) and Oncotype DX, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (NCCN Guidelines: Breast Cancer; SSO-ASTRO-ASCO margin guideline 2016), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (localised dcis, breast conservation), which of the standard options do you recommend and why?
   Why: Guideline options include: Lumpectomy to 2 mm margins followed by whole-breast radiotherapy (hypofractionated), with radiotherapy omission considered for low-risk lesions (RTOG 9804 criteria or genomic assay).
6. Am I a candidate for Oncotype DX, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Is Sentinel lymph node biopsy the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
   Why: A single standard does not mean a single choice; timing and trials are decisions too.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (NCCN Guidelines: Breast Cancer), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (extensive or multicentric dcis), which of the standard options do you recommend and why?
   Why: Guideline options include: Mastectomy with sentinel node biopsy and optional reconstruction; radiotherapy not needed after mastectomy with clear margins.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Tamoxifen and Endocrine therapy (SERMs, AIs, SERDs), which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (NSABP B-24, B-35; IBIS-II DCIS; TAM-01), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (er-positive dcis after breast conservation), which of the standard options do you recommend and why?
   Why: Guideline options include: Tamoxifen (or anastrozole in postmenopausal women) for five years to reduce ipsilateral and contralateral breast events; low-dose tamoxifen is an option (TAM-01).
6. Am I a candidate for Tamoxifen, and what side effects should I expect?
   Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

1. Between Active surveillance and Mammography & tomosynthesis, which do you recommend for me, and what about my case would make you choose differently?
   Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
   Why: The aim shapes how much side effect and disruption is worth accepting.
3. What happens if I delay, or decline this step for now? Is the decision reversible?
   Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
4. Does your recommendation follow the current guideline (COMET (JAMA 2024)), and if it departs from it, why?
   Why: Departures from guidelines are sometimes right for an individual; they should be explained.
5. For my situation (low-risk dcis), which of the standard options do you recommend and why?
   Why: Guideline options include: Active monitoring with mammography every six months and optional endocrine therapy, in trials (COMET, LORIS, LORD) or after shared decision-making where guidelines allow.

Add these to your appointment list, or take the full question set for this cancer.