Ductal carcinoma in situ : a ticking time bomb

Abstract

85 ISSN 1758-1923 10.2217/BMT.12.69 © 2013 Future Medicine Ltd Breast Cancer Manage. (2013) 2(2), 85–88 The goal of screening is to detect cancer early and improve survival. Most screen-detected cancers should be treated effectively with fewer and less morbid therapies. Over the last decade, the quality of mammography and other imaging modalities for breast cancer screening has improved, resulting in a dramatic increase in the number of women diagnosed with noninvasive ductal carcinoma in situ (DCIS). In 2005, almost 60,000 cases of DCIS were recorded in the USA, representing nearly a quarter of all screen-detected cancers [1]. Evidence that earlier detection of DCIS improves diseasespecific survival is controversial, however, and many groups question the value of current breast-screening programs. Despite technological improvements in imaging, treatment for DCIS has not changed. Women with small foci of lowgrade DCIS are often treated with a onesize-fits-all barrage of surgery, radiotherapy and hormonal therapy. Analyses of trends over time show that, since 1998, both the mastectomy rate and the contralateral prophylactic mastectomy rate for DCIS have increased dramatically. DCIS is an independent risk factor for bilateral mastectomy in many studies, despite the results of the NSABP B-17 and B-24 trials, which demonstrate the safety of breastconserving surgery (BCS) for DCIS [2]. For those selecting BCS, there also appears to be a very high rate of intervention in the first decade after treatment [3], leading many to wonder if, from both a psychological and an economic standpoint, BCS is really worth it. Here, we present some current therapies and opportunities for future research regarding the treatment of DCIS.