Revised after meeitng with Dr. Newman (3/6/00).

Reviewed with
Dr. Valero, wording update for LCIS first treatment box, 4/10/00.

Breast Cancer (Noninvasive)

DIAGNOSIS WORKUP LOCAL TREATMENT SYSTEMIC SURVEILLANCE/
TREATMENT FOLLOW-UP

Tamoxifen to Physical exam with clinical

LCIS Bilateral diagnostic Excision (preferred) or breast exam yearly
mammography be discussed
Stage 0 Consider bilateral total Diagnostic mammography
Pathology review with patient
Tis N0 M0 with/without reconstrution yearly if observation chosen
(BrM3)
Refer to Stage II
Yes on Invasive Breast
Cancer Guideline
DCIS Bilateral diagnostic Yes
Large area Total mastectomy Nodes
mammography
Stage 0 _(>= 4cm) or with/without lymph positive?
Pathology review multicentric Physical exam with clinical
Tis N0 M0 disease node dissection breast exam yearly
with/without Diagnostic mammography
reconstruction No
of contralateral breast
yearly
Biopsy
margins
negative?
resection may be Mastectomy
necessary to (unable to get negative margins)
obtain -ve
margins No Total mastectomy without lymph Tamoxifen to
node dissection with/without be discussed
reconstruction with patient
Yes (BrM3)

Breast
Conservation
Total mastectomy without lymph
node dissection with/without
reconstruction
Small No Excision and radiotherapy
(<1 cm) , Physical exam with clinical
unicentric, low breast exam every 6
grade Yes months for three years
Total mastectomy without
lymph node dissection with/ then yearly
without reconstruction or Bilateral diagnostic mam-
Excision and radiotherapy mography 6 months after
Excision alone XRT, then yearly

No additional local
treatment if widely'
negative margins (at
least 10 mm)