Ductal Carcinoma In Situ, Complexities and Challenges

Abstract

The incidence of ductal carcinoma in situ (DCIS), a noninvasive form of breast cancer, has increased markedly in recent decades, and DCIS now accounts for approximately 20% of breast cancers diagnosed by mammography. Laboratory and patient data suggest that DCIS is a precursor lesion for invasive cancer. The appropriate classification of DCIS has provoked much debate; a number of classification systems have been developed, but there is a lack of uniformity in the diagnosis and prognostication of this disease. Further investigation of molecular markers should improve the classification of DCIS and our understanding of its relationship to invasive disease. Controversy also exists with regard to the optimal management of DCIS patients. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery has become the standard approach. Three randomized trials have reported a statistically significant decrease in the risk of recurrence with radiation therapy in combination with lumpectomy compared with lumpectomy alone, but there was no survival advantage with the addition of radiotherapy. Two randomized trials have suggested an additional benefit, in terms of recurrence, with the addition of adjuvant tamoxifen therapy, although in one trial the benefit was not statistically significant. Current data suggest that tamoxifen use should be restricted to patients with estrogen receptor-positive DCIS. Neither trial demonstrated a survival benefit with adjuvant tamoxifen. Ongoing and recently completed studies should provide information on outcomes in patients treated with lumpectomy alone and on the effectiveness of aromatase inhibitors as an alternative to tamoxifen.

Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] However, there remain many unanswered questions about the natural history of DCIS. In particular, factors associated with the progression of DCIS to invasive breast carcinoma remain poorly defined because most patients with DCIS have been treated with methods aimed toward complete eradication of the lesion, such as total mastectomy, excision and radiotherapy, or planned wide excision without radiotherapy.…”

Vibrational spectroscopic mapping and imaging of tissues and cells

“…As an example of an application of imaging, we describe studies on a ductal carcinoma in situ (DCIS), which is a pre-invasive cancer localized within the breast ducts (Leonard and Swain 2004). As epithelial cells proliferate, the architecture of the duct or the terminal ductal-lobular unit (TDLU) of the breast alters (Burstein et al 2004;Skinner 2003).…”

The challenge of being diagnosed and treated for ductal carcinoma in situ (DCIS)

“…DCIS is a non-invasive breast condition where cancer cells are confined to the ducts of the breast (Leonard and Swain, 2004). Following treatment most patients have an excellent prognosis and few will ultimately die of breast cancer (Ernster et al 2000).…”