Met today. 2825 Capitol Ave / Buhler 2800 L St #300 · 916-733-9660. Full audio (~67 min) + Otter export integrated into stage0 knowledge. Her stance: off-trial watch not recommended at home; supports UCSF/MDACC non-operative trials; lumpectomy remains available; trial exit free.
Note: This event was not on Tim’s M365 or empty Gmail-labeled iCloud calendars; confirmed from calendar UI screenshot.
| Board | American Board of Surgery |
|---|---|
| Medical school | University of Vermont |
| Residency | Vanderbilt University Medical Center (general surgery) |
| Fellowship | Surgical Oncology, City of Hope; oncology research, National Cancer Institute (NIH) |
| Languages | English, Arabic (Sutter: fluent); Spanish listed on some directories |
| NPI | 1508849001 |
| Societies | ACS · Society of Surgical Oncology · ASCO · American Society of Breast Surgeons · American Society of Breast Diseases · Komen · ACS |
| Listed procedures | Lumpectomy · nipple-/skin-sparing mastectomy · prophylactic mastectomy · sentinel node · brachytherapy · oncoplastic surgery |
| Caseload signal | Claims profiles show frequent breast cancer and DCIS (ICD D05) diagnoses; high volume of partial and complete mastectomy codes |
| Research / registry | NCI-era IL-2 / brain-metastases co-authorship (not DCIS-specific). Sub-investigator, PREDICT Registry for DCIS + DCISionRT — genomic RT decision support after excision |
Guirguis explicitly supported non-operative management only via clinical trial. Named UCSF and MD Anderson as top fits; MSK and Northwestern also; discouraged Stanford for this trial question. Dawn can leave a trial and operate anytime. Genetic testing recommended (age). DCISionRT commercial after surgery; genomic tools may gate trial entry.
Knowledge: .praxis/dawn-gradient/guirguis-consult-2026-07-22.json · corrected transcript in sources/clinical/…/consult-transcript-corrected.md · Stage 0 hub /stage0
Proposed first protocol: observation-first / risk-adapted monitoring + continue individualized HRT when absolute risks support it. Pathology anchor: intermediate grade + comedonecrosis, ER90% / PR60%, DPS-26-17107.
| Dimension | Strong Standard high-quality Sutter breast surgical oncology (training + volume + ratings) |
|---|---|
| Breast conservation / oncoplastic | Strong Lumpectomy + oncoplastic listed; conservation procedures common in claims |
| DCISionRT / RT right-sizing after excision | Moderate–strong PREDICT registry sub-I exposure — ask explicitly for the test after surgery |
| COMET-style active monitoring first | Weak (public) Profile is surgical; no public COMET PI / watch-DCIS advocacy under her name. Comedonecrosis usually excludes classic COMET eligibility anyway |
| Continue HRT with active HR+ DCIS | Uncertain / likely cautious No public endorsement found for continuing combined E+P±T with untreated ER+ DCIS; standard practice often pauses until local plan set |
Excellent home-path breast surgical oncologist. Expect a surgery-first / guideline framing with possible genomic radiation de-escalation after excision. Do not assume she defaults to observation-first or green-lights continuing HRT — bring absolute-risk questions and the one-pager; negotiate the least-invasive safe path.
.praxis/dawn-gradient/surgeon-guirguis-brief.jsonVerify affiliation and availability before citing in external materials. Contacts change.
Boundary: Draft family decision-support for Dawn’s consult. Not a medical order, not a diagnosis, not a substitute for Dr Guirguis’s clinical judgment. Agents research and organize; oncologists advise; Dawn decides.