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Candidate Shift — Gynecomastia: Exclude Cancer and Causes First; Combine Liposuction With Pull-Through Adenectomy (Addendum Summary, Ch 6)Do not excise early gynecomastia: first exclude male breast cancer, drugs and endocrine causes; for persistent fibrous Grade II–III disease, combine liposuction with pull-through subareolar adenectomy.Candidate Shift — Nipple Discharge & Zuska's Fistula: Classify First, Excise the Diseased Duct (Addendum Summary, Ch 6)Separate physiological discharge (reassure) from pathologic single-duct discharge (image, then microdochectomy), and treat recurrent Zuska's fistula with smoking cessation plus complete duct and fistula excision.Candidate Shift — Phyllodes Tumours: Grade-Dependent Margins, No Routine Axillary Staging (Addendum Summary, Ch 6)Excise borderline and malignant phyllodes with >=1.0 cm margins and omit routine axillary SLNB/ALND; benign phyllodes needs complete excision only.Practice Shift — Granulomatous Mastitis: Exclude Infection Before Any Steroid or Methotrexate (Table 6.1)Work up suspected granulomatous mastitis by presentation, epidemiology, imaging and core biopsy with targeted stains, lipophilic culture and TB PCR — and start corticosteroids or methotrexate only after infection is excluded and IGM is confirmed.Practice Shift — Low-Risk DCIS Active Monitoring (Emerging Option) & Exact BCS Margin Definitions (Table 6.1)Keep low-risk DCIS monitoring strictly separate from invasive cancer — an emerging shared-decision option for the COMET population only — and apply the exact BCS margins: 'no ink on tumor' for invasive carcinoma, >=2 mm for pure DCIS, no routine wider re-excision.Practice Shift — Neoadjuvant-First Sequencing in Stage II–III TNBC/HER2+ & Exact HER2-Low Classification (Table 6.1)Refer Stage II–III TNBC and HER2+ disease for neoadjuvant systemic therapy before surgery (clips in first), and report exact HER2 IHC scores — HER2-low is a predictive category for T-DXd in advanced disease, not a binary label or an early-stage trastuzumab indication.Practice Shift — SLNB Omission Only in the Strictly Eligible Postmenopausal Subset (Table 6.1)Consider omitting SLNB only in postmenopausal patients aged >=50 with unicentric cT1 (<=2.0 cm) Grade 1–2 HR+/HER2- cancer and a negative axillary ultrasound — never as a blanket rule for all cN0 breast cancer.Practice Shift — Targeted Axillary Dissection After NST in cN1-to-ycN0 Responders (Table 6.1)Stage the axilla after neoadjuvant therapy with targeted axillary dissection — clipped node out plus dual-tracer SLNB with >=2–3 sentinel nodes — instead of mandatory Level I–II ALND for every cN1 converter.Stepwise Clinical Decision Pathway — Breast Surgical Oncology (§6.2)Omit sentinel node biopsy only in the exact ASCO 2025 population — and exclude infection before any steroid in granulomatous mastitis.
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BRE-LUM-COMP-01 — Bleeding / haematoma (BRE-LUM-COMP-01) 🟢2–5% (2025 day-care series: haematoma 2.7–4.0%) — Postoperative bleeding or haematoma following breast lump excisionBRE-LUM-COMP-02 — Wound infection (BRE-LUM-COMP-02) 🟢2–5% (pooled 3.8% in the Platt meta-analysis of 2,587 breast procedures, as cited by Vitug & Newman; 2025 series: infection 1.3%) — Wound infection following breast lump excisionBRE-LUM-COMP-03 — Seroma (BRE-LUM-COMP-03) 🟢5–10% — Postoperative seroma formation following breast lump excisionBRE-LUM-COMP-04 — Sensory change / numbness (BRE-LUM-COMP-04) ⚪No figure published — qualitative wording only — Altered sensation or numbness around the operative siteRSK-BRC-FH-01 — RR by no. of affected FDRsfirst-degree · 1 FDR 1.80 · 2 FDR 2.93 · ≥3 FDR 3.90 — Risk ratio by number of affected relatives (mother/sister/daughter): (99% CI 1.69–1.91) · (2.36–3.64) · (2.03–7.49) vs no affected FDR. Mother vs sister did not differ substantiallyRSK-BRC-FH-02 — Cumulative incidence 0/1/2 FDRAbsolute cumulative incidence · 0 FDR 1.7% · 1 FDR 3.7% · 2 FDR 8.0% · 0 FDR 7.8% · 1 FDR 13.3% · 2 FDR 21.1% — (more-developed countries), by affected FDRs — to age 50: ; to age 80: (breast-cancer death to 80: 2.3% / 4.2% / 7.6%)RSK-BRC-FH-03 — Woman <50, FDR diagnosed <50<50 years · <50 years · 3.3 — Woman with an FDR diagnosed : RR (95% CI 2.8–3.9) — the highest common familial stratum in the older pooled literatureRSK-BRC-FH-04 — SDR only / mother+sisterSecond-degree · 1.5 · and — relative only: RR (1.4–1.6); mother alone 2.0 (1.8–2.1); sister alone 2.3 (2.1–2.4); mother sister 3.6 (2.5–5.0)RSK-BRC-FH-05 — BRCA1/2 carrier frequency~1 in 400 to 1 in 800 · ~1 in 40 (2.5%) — Population carrier frequency, BRCA1 or BRCA2 pathogenic variant: individuals (general population, excluding Ashkenazi Jewish ancestry); in Ashkenazi Jewish populationsRSK-BRC-FH-06 — BRCA1 breast cumulativeBRCA1 — breast cancer cumulative risk (prospective): · 43% · 66% · 72% — to age 50 (39–48) · to 70 (61–72) · to 80 (65–79). Incidence rises steeply to age 30–40 then plateaus at 20–30 per 1,000 person-yearsRSK-BRC-FH-07 — BRCA2 breast cumulativeBRCA2 — breast cancer cumulative risk (prospective): · 35% · 61% · 69% — to age 50 (29–41) · to 70 (55–68) · to 80 (61–77)RSK-BRC-FH-08 — Ovarian cumulative @80Ovarian cancer cumulative risk to age 80: · 44% · 17% — BRCA1 (36–53) · BRCA2 (11–25); to age 70: BRCA1 41% (33–50) · BRCA2 15% (10–23)RSK-BRC-FH-09 — Contralateral BC @20 yContralateral breast cancer: · 40% · 26% — cumulative risk 20 years after first breast cancer — BRCA1 (35–45) · BRCA2 (20–33)RSK-BRC-FH-10 — FH modifies carrier riskFamily history modifies risk even within carriers: · 1.99 · 1.91 · 73% vs 53% · 65% vs 39% — ≥2 affected 1st/2nd-degree relatives vs none — HR (1.41–2.82) BRCA1, HR (1.08–3.37) BRCA2; cumulative breast risk to age 70 with ≥2 affected relatives vs none: BRCA1 · BRCA2RSK-BRC-FH-11 — PALB2 cumulativePALB2 (loss-of-function): · 14% · 35% · 33% · no · 58% · ≥2 FDRs — cumulative breast risk (9–20) by 50 · (26–46) by 70; by family history at age 70: (25–44) with family history → (50–66) with affected at 50. Age-specific RR vs population: 8–9× (<40 y), 6–8× (40–60 y), ~5× (>60 y); male breast cancer RR 8.3RSK-BRC-FH-12 — NICE NG164 risk categoriesNICE <17/17–<30/≥30% · ACS MRI ≥~20–25%, start 30 — NICE NG164 risk categories (lifetime risk from age 20): near-population <17% · moderate 17–<30% · high ≥30% (risk between ages 40–50: <3% / 3–8% / >8%). NICE states general-population lifetime risk ≈ 11%. Surveillance (no personal history): moderate risk → annual mammography 40–49; high risk (≤30% carrier probability) → annual mammography 40–59; known BRCA1/2 or untested >30% carrier probability → annual MRI 30–49 + annual mammography 40–69. ACS (Saslow 2007): annual MRI in addition to mammography when lifetime risk ≥~20–25% by family-history-based models (BRCAPRO/Claus/Tyrer-Cuzick), for BRCA carriers, and for untested FDRs of carriers; high-risk screening starts at age 30; MRI against at <15% lifetime risk; 15–20% = insufficient evidence