Ductal carcinoma in situ – update on risk assessment and management

Abstract

Ductal carcinoma in situ (DCIS) accounts for ~20-25% of breast cancers. While DCIS is not life-threatening, it may progress to invasive carcinoma over time, and treatment intended to prevent invasive progression may itself cause significant morbidity. Accurate risk assessment is therefore necessary to avoid over- or undertreatment of an individual patient. In this review we will outline the evidence for current management of DCIS, discuss approaches to DCIS risk assessment and challenges facing identification of novel DCIS biomarkers.

Relationship of the Breast Ductal Carcinoma In Situ Immune Microenvironment with Clinicopathological and Genetic Features

“…Prediction of those cases of DCIS likely to progress to invasive carcinoma is imprecise (17). Histopathologic factors such as nuclear grade, hormone receptor expression, and comedo necrosis and genomic alterations including copy number changes have been shown to correlate with disease progression (17,18).…”

Importance of cost‐effectiveness and value in cancer care and healthcare policy

“…In 1975, the incidence was 5.8 per 100,000. Currently, DCIS represents 20–25% of breast cancers[26–28]. The rise in incidence has largely been attributed to breast cancer screening programs [29].…”

Should local treatment of breast ductal carcinoma in situ be the same as the treatment of early invasive breast cancer

“…Depending on the tissue architecture, DCIS can be defined as solid, cribriform, papillary and micropapillary; whilst depending on the malignancy grade, as: poorly-, moderately-and highly differentiated and -depending on the presence of the comedo type necrosis -as comedo type carcinoma (with a more aggressive clinical course) and non-comedo type carcinoma. Intraductal spread of the disease in connection with an irregular routing of the ducts and difficulties in macroscopic evaluation of the scope of the lesions illustrates well the deceptive character of the disease and the widely understood heterogenicity of the DICS requires some significant evaluation of the therapeutic management [2]. The risk of development of an invasive form of cancer, which -depending on the subtype of DCIS -is 20-30% within 10 years and is 15 times greater than the average risk of breast cancer morbidity in the general population [3] of key importance for the choice of the scope of treatment.…”

“…The basic arguments for the treatment of ductal carcinoma in situ in the same way as early invasive cancer comprise: -unknown natural history of untreated DCIS [16]; -high risk of undervaluation of the invasive component in the core-needle biopsy [10,[16][17][18]; -increase of recurrence risk with the progress of time [3,[19][20][21]; -lack of verified separators of the groups with the risk of adverse course of the disease [1,2,20]; -the results of the clinical studies confirming the justification of combined local treatment [22][23][24][25][26]; -and the proof that the clinical course of DCIS is the same as early invasive breast cancer [27,28]; -the lack of clinical studies which could justify a limitation of the treatment scope [28][29][30]. Given the fact that a large share of ductal carcinoma in situ is diagnosed as a small lesion seen only in a mammography image, and then treated with a mammotomy biopsy, a substantial part of DCIS is resected during this procedure.…”

“…According to the published data, in 10 to 50% patients with ductal carcinoma in situ diagnosed during a core-needle or mammotomy biopsy, there is a risk of the underestimation of the co-existence of an invasive component, which is illustrated by microscopic evaluation performed after the surgical resection of the lesion [2,10,17,18]. In the opinion of the authors of this meta-analysis, which comprised 7350 subject with a diagnosis of DCIS established with a core-needle biopsy, a consequence of underestimation of the risk of the presence of an invasive component was the delay of the correct diagnosis and treatment in one out of five cases.…”