@Anking-Maintainers bump
@Ahmed7 donât think I can tag maintainers anymore 
Iâll add you back sir
You should be able to mute all notifs from the group I believe
@herstein.jacob What do you think about moving âbilateral mastectomyâ to the extra section?
What would be the reason to move? Seems ok to me as is
1- UTD generally does not recommend it
2- Itâs under the same risk reduction category as tamoxifen
3- One of the AMBOSS questions (NEJM) mentions that itâs invasive, and the correct option is tamoxifen
4- Maybe add ânext step in managementâ to the question
5- I donât see any question where the answer would be mastectomy âmost likely, the answer would be tamoxifenâ
6- I am ok with the current suggestion, but here is my suggestion
What is the best next step in the management of lobular carcinoma in situ (LCIS) discovered on core needle biopsy?
Low-risk LCIS: {{c1::surveillance ± tamoxifen}}
High-risk LCIS: {{c1::surveillance + tamoxifen}}
Nonclassic LCIS: {{c1::excisional biopsy + surveillance ± tamoxifen}}
Extra section
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LCIS is always ER (+), so SERMs are ideal for preventing disease progression
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Nonclassic LCIS requires excisional biopsy to rule out invasive carcinoma
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vs. DCIS, which requires lumpectomy to negative margin
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Prophylactic bilateral mastectomy can be considered as a risk reduction strategy in patients with very high-risk LCIS
@mohannadkh10 I see what you are saying, but I think that the three answers you give in your version are way too similar to each other to really help learners grasp the key point. What you suggested isnât necessarily wrong, but itâs not very simple. Think that the version I have suggested using +/- helps clarify that based on the risk, you can be more aggressive with risk reduction if patient prefers. I would maybe just add a note to extra that mastectomy is generally reserved for very high risk patients (e.g., strong family history or genetic predisposition)
I see your point, and I kind of agree with it âMy edit aims to make it a stepwise approachâ
I donât mind your change at all, and I think itâs needed, but I didnât want to include mastectomy in the text since itâs almost always the wrong answer imo but we can solve this by adding a small note in the extra field as you suggested