Abstract
Ductal carcinoma in-situ DCIS is a heterogeneous entity in breast neoplasm with unpredictable biological behavior. This poses challenge in the management of DCIS. Various trials on DCIS have shown good outcome with integral treatment of adequate surgery, radiotherapy and hormonal therapy. Identification of subgroup of DCIS for radiotherapy and hormonal therapy could improve recurrence rate, contralateral tumours incidence and perhaps overall survival. Various risk score calculations could help to direct radiotherapy and hormonal treatment verses surgery alone and to avoid over treatment. Oncotype DX assay could be a new way of risk calculation to direct types of DCIS treatment. The recent increased use of MRI could increase the detection of DCIS and a more accurate extent of disease estimation. This article is a summary of major literatures and major trials result for DCIS.
Highlights
The introduction of national mammographic screening programmes and the increasing use of digital mammography and magnetic resonance imaging (MRI) have dramatically changed the clinical presentation of ductal carcinoma in-situ (DCIS)
DCIS made up a small proportion of all breast cancers and was only diagnosed in patients presenting with a palpable mass, pathological nipple discharge or occasionally found as an incidental biopsy finding
An analysis of long term data on patients treated for DCIS from the NSABP B-17 and NSABP B-24 trials [11] showed that at 15 years, the RT treated patients had significantly fewer local recurrences and that this effect increased over time
Summary
The introduction of national mammographic screening programmes and the increasing use of digital mammography and magnetic resonance imaging (MRI) have dramatically changed the clinical presentation of ductal carcinoma in-situ (DCIS). DCIS made up a small proportion of all breast cancers and was only diagnosed in patients presenting with a palpable mass, pathological nipple discharge or occasionally found as an incidental biopsy finding. High spatial resolution MRI seems to be more sensitive than mammography in the detection of high and intermediate grade DCIS [2]. It is considered to be the precursor of the most invasive breast cancers, not all DCIS will progress to this stage. The overall progression to invasive breast cancer has been reported to range from 14% to 75% [1].
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