Abstract
Ductal carcinoma in situ (DCIS) is a non-invasive malignancy confined within the basement membrane of the breast ductal system. There is a lot of disparity in the natural history of DCIS with an estimated incidence of progression to invasive ductal carcinoma between 20% to 53% over ten or more years after initial diagnosis. The surgical and adjuvant management of DCIS has advanced significantly in the last couple of decades. Nonetheless, surgeons, medical oncologists, and radiation oncologists, along with their patients, still depend on conventional clinical and pathologic risk factors to make management decisions. Irrespective of the management strategy, long-term survival is excellent. The debate around DCIS relates to preventing either under-treatment or over-treatment. In this paper, we will review the incidence and management options of DCIS. Additionally, we will focus on several current disputes related to the management of DCIS, including breast conserving surgery, the role of radiation in breast conservation surgery, sentinel node biopsy in DCIS, hormonal therapy, various risk stratification schemes, and the option of active surveillance for low-risk DCIS.
Highlights
Data is sparse on the natural history of Ductal carcinoma in situ (DCIS), but some series have reported the outcomes for women many years after undergoing a surgical biopsy that was interpreted as benign that contained an unrecognized area of DCIS [3]
Five 11G biopsy needles need to be taken to meet LORD’s eligibility criteria ○ Whatever needle size is applied, it is essential to confirm that the biopsies contain representative calcifications via biopsy radiography, microscopy, or both ○ Any size DCIS ○ Marker placement at biopsy site(s) in the breast ○ Good correlation between pathological and radiological findings i.e. both findings confirm low-risk DCIS and no suspicion of high-grade DCIS or invasive breast cancer ○ Prior surgery of the ipsilateral breast because of a benign lesion allowed ○ ASA score 1 or 2 ○ Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations
The authors concluded that the Memorial Sloan Kettering Cancer Center (MSKCC) DCIS nomogram provided good prediction of the five- and ten-year local recurrence when applied to a population of patients with DCIS treated with BCT in a community-based practice [51]
Summary
Ductal carcinoma in situ (DCIS) is a malignant intra-ductal proliferation of epithelial cells within the tubular-lobular system of the breast with no microscopic. Data is sparse on the natural history of DCIS, but some series have reported the outcomes for women many years after undergoing a surgical biopsy that was interpreted as benign that contained an unrecognized area of DCIS [3]. These data identified that approximately 20% to 53% of these women developed ipsilateral invasive carcinoma. Collins et al [4], in the Nurses’ Health Study, singled out 13 women who were found to have DCIS on reexamination of the surgical biopsies that were previously diagnosed as benign Ten of these women subsequently developed breast cancer; all were ipsilateral, four were DCIS and six were invasive. Other risk factors for DCIS include: older age, proliferative breast disease, increased breast density, nulliparity, older age at first live birth, history of breast biopsy, early menarche, late menopause, long-term use of postmenopausal hormone replacement therapy, and elevated body mass index in postmenopausal women, are the same as those for invasive breast cancer, but in many cases, the relationship between a given characteristic and invasive cancer is stronger than the relationship between that characteristic and DCIS [11]
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