The Senologic International Society Survey on Ductal Carcinoma <i>In Situ</i>: Present and Future

Abstract

Objective: Therapeutic management of ductal carcinoma in situ (DCIS) is heterogeneous among countries worldwide, and some treatment indications are still controversial. To investigate DCIS management in different countries; identify both consensual practices and controversial topics; and survey opinions about the future management of DCIS. Materials and Methods:The Senologic International Society network members participated to an online survey using a questionnaire, between November 2021 and February 2022.Results: Twenty-two responses from 20 different countries showed that organized breast cancer screening programs were present for 87% participants, and DCIS cases represented 13.7% of all breast cancers. Most participants used the grade classification (100%), the morphological classification (78%) and performed immunohistochemistry assays (73%). In case of conservative treatment, the mean re-excision rate was 10.3% and clear margins of mean 2.5 mm were considered healthy. Radical mastectomy rate was 35.5% with a breast reconstruction rate of 53%. Tumor bed boost indications were heterogeneous, and 73% of participants indicated hormone therapy for hormone-positive DCIS. Surgery and radiotherapy omission for some low-risk DCIS were considered by 73% of participants. Multigene assays were used by 43% of participants. Concerning future changes in DCIS management, participants mostly answered surgical de-escalation (48%), radiotherapy de-escalation (35) and/or active surveillance for some cases (22%). Conclusion:This survey provided an overview of the current practices of DCIS management worldwide. It showed that some areas are rather consensual: incidence increases over time, treatment in young women, pathological classifications, definition of healthy margins, the skin-sparing mastectomy and

Tools to Guide Radiation Oncologists in the Management of DCIS

“…Until recently, the delivery of boost dose to the tumour bed has been controversial, with some reports showing benefits for young women and others only for positive surgical margins [81,82]. An international survey [7] showed a great heterogeneity for boost indications: about one-third of the physicians never delivered boost and the remaining two-thirds split over delivering it always or only in the presence of risk factors.…”

“…The survey by Mathelin et al [7] showed that 73% of the physicians are in favour of some kind of therapy de-escalation (surgery or RT) for selected low-risk DCIS, especially for elderly women.…”

“…The decision making about RT omission lies in the perception of both physicians and patients of a small advantage in local control [3,7], reinforced by the fact that breast cancer-specific survival (BCSS) does not seem to be affected.…”