Getting the right balance in treatment of ductal carcinoma in situ (DCIS)

Ian Fentiman

doi:10.14319/ijcto.0102.9

Abstract

As a result of mammographic detection, ductal carcinoma in situ (DCIS) is an increasing problem in breast clinics. Both histopathology and molecular profiling can identify subtypes likely to progress to invasive disease, but there is no subgroup with a zero likelihood of subsequent invasion. In patients with low/intermediate grade DCIS, if breast irradiation is not being carried out after free margins have been achieved the patient should be aware of the risks of withholding and the benefits and morbidity of adjuvant radiotherapy. Either tamoxifen or an aromatase inhibitor may be of value in those with low/intermediate ER+ve disease if radiotherapy is being withheld. For those patients with extensive or multicentric DCIS, mastectomy is the appropriate treatment. This is best combined with sentinel node biopsy and all such cases should be offered immediate reconstruction. ---------------------------- Cite this article as: Fentiman IS. Getting the right balance in treatment of ductal carcinoma in situ (DCIS). Int J Cancer Ther Oncol 2013; 1 (2):01029. DOI : http://dx.doi.org/10.14319/ijcto.0102.9

Highlights

In the not so distant past, no real distinction was made between invasive breast cancer and ductal carcinoma in situ (DCIS), both being treated by mastectomy, often including an axillary clearance
Such radical surgery for DCIS became questioned as results emerged from randomised trials indicating that breast conservation was a safe and effective alternative to mastectomy for invasive breast cancer.[1, 2, 3, 4, 5]
There was a reduction in both DCIS relapse and invasive progression in the tamoxifen arm

Summary

Introduction

In the not so distant past, no real distinction was made between invasive breast cancer and ductal carcinoma in situ (DCIS), both being treated by mastectomy, often including an axillary clearance. In B24, after a median follow-up of 163 months, the overall ipsilateral breast recurrence rate was 19% in the placebo arm and 9% in the tamoxifen group.[19] There was a reduction in both DCIS relapse and invasive progression in the tamoxifen arm.

Results

Conclusion