LOL...I've had a busy week and been unable to respond until now, but I was going to say the exact same thing as droliver: the OP is making it harder than it needs to be.
Yes, NCCN guidelines are used by breast surgeons and other oncologists. However, they can be very overwhelming and difficult to wade through. I would not recommend that a GS taking the oral boards be anything but knowledgeable about their existence rather than memorizing them. The ABS does not expect anymore than that.
The main question is what to do with Stage II and III.
Is it necessary to have a different treatment for IIA, IIB, IIIA, IIIB, IIIC?
Or can I treat all stage III the same way I treat IBC - neo and then surgery vs. palliation based on response?
As droliver notes, any patient with known metastatic disease, inflammatory breast cancer or a large tumor (> 5 cm), can be referred to a medical oncologist for consideration of neoadjuvant chemotherapy (NAC). Thus, the treatment algorithm does not typically vary (for purposes of the boards) for 2A-3C. Management will depend on response (except in the case of IBC where there is no role for breast conservation). It is not necessary for purposes of the oral boards to have a different scenario for IIA, IIB, IIIA, IIIB, IIIC.
For breast some scenarios you may reasonably expect (outside of the standard breast cancer case):
1) management of bloody nipple discharge;
2) management of discordant needle biopsies
3) management of breast cancer in pregnancy
4) management of imaging abnormalities (they want to hear that you would either do or refer for a needle biopsy rather than doing an excisional biopsy)
You should be able to discuss:
1)
Z-0011 and management of the axilla. Despite the lack of universal acceptance, be aware that SESAP 15 endorses this as well: breast conservation patients with positive lymph nodes are being offered axillary RT and not axillary node dissection.
2) margin width; the classic question of DCIS vs LCIS at margin, what margin you find acceptable (most say 2 mm)
3) adjuvant treatments; I do not think that you need to know details of side effects of chemotherapy. It is enough to know AC+T x 4-6 cycles, Herceptin for 1 year for Her-2/neu positive patients. You might be asked about SERMs. You should know about partial breast irradiation as a possible option after breast conservation.
4) use of Oncotype/Mammaprint/genetic testing - who are candidates for these
While I do a lot of nipple-sparing mastectomies, I don't think that has become common fodder for ABS exams as the ASBS is still in the process of collecting data for the registry. If asked and you don't know the indications, it is more than reasonable to state, "I am not comfortable performing that procedure in the face of malignancy...". Honestly, its not an operation general surgeons are doing with any regularity unless their practice is almost all breast. I cannot see the board expecting otherwise.
FWIW, I am not aware of a portable accurate resource which distills all this down. You are not alone; when I was studying for boards, the most common areas of confusion for my colleagues seemed to be breast related.
