Controversies in the Treatment of Ductal Carcinoma in Situ

Abstract

Ductal carcinoma in situ (DCIS) accounts for 20% of all newly diagnosed breast cancers. Mastectomy was once the gold standard for the treatment of DCIS; however, breast-conserving surgery (BCS) has been adopted as the treatment of choice for patients with small, screen-detected lesions. Both adjuvant radiation and hormonal therapy following BCS have been demonstrated in randomized trials to reduce the risk of invasive recurrence, but neither affects survival. With the variety of surgical and adjuvant treatment options available, there has been great interest in tailoring the treatment to the individual, with the goal of optimizing the balance of risks and benefits according to the values and priorities of the woman herself. Prospective studies of women with “low-risk” DCIS have successfully identified women at lower than average risk, but have not achieved the goal of identifying a subset of women with DCIS at minimal risk of recurrence after surgical excision alone.

Concordance of breast fine needle aspiration cytology interpretation with subsequent surgical pathology: An 18‐year review from a single sub‐Saharan African institution

“…As a part of the triple test , breast FNAC misses less than 1% of breast cancers . With concordance of pathological, radiological and clinical impressions, patients can proceed to definitive surgery with cytopathology material alone, though confirmation of invasion either through CNB of the breast mass or FNAC of abnormal axillary lymph nodes is necessary prior to contemplation of intervention within the axilla . If any two of the three triple test parameters are discordant, patients should undergo excisional biopsy for further histopathological evaluation .…”

Ductal Carcinoma In Situ with Diffuse Growth Distribution: A Potentially Lethal Subtype of “Preinvasive” Disease

“…Treatment was then further refined in response to multiple DCIS randomized trials which demonstrated that the addition of radiation therapy (RT) to lumpectomy reduced ipsilateral DCIS and invasive recurrences, and among estrogen receptor (ER) positive patients endocrine therapy (ET) such as tamoxifen reduced some combination of in situ and invasive recurrences in either breast [2,3]. Notably neither of these adjuvant therapies resulted in a reduction in breast cancer mortality (BCM) [2,3]. Importantly, these trials investigated patients undergoing lumpectomy, not mastectomy, in spite of the fact that mastectomies represent between 27-56% of the surgeries received by DCIS patients [4][5][6][7][8][9][10].…”

Subtype-specific characterization of breast cancer invasion using a microfluidic tumor platform

“…[1,2] This pre-cancerous lesion progresses to invasive ductal carcinoma (IDC), which will need major treatments including chemotherapy, radiation, and surgical therapies. [3][4][5] Understanding and characterization of the transition of DCIS into IDC can significantly improve the treatment and management of breast cancers. Extensive studies have been performed to identify both genetic and environmental drivers and markers of the progression from DCIS to IDC, as reviewed elsewhere.…”