Ductal carcinoma in situ of the breast |
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Authors: | Jennifer L Peterson Laura A Vallow Stephanie L Hines Steven J Buskirk |
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Institution: | (1) Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA;(2) Department of Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA; |
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Abstract: | Ductal carcinoma in situ (DCIS) of the breast is a noninvasive form of breast cancer that has increased in incidence over
the past several decades secondary to screening mammography. DCIS now represents 20–30% of all newly diagnosed cases of breast
cancer. Patients with DCIS typically present with an abnormal mammogram, and diagnosis is most commonly obtained with an image-guided
biopsy. Historically, mastectomy was considered the primary curative option for patients with DCIS. However, treatment of
DCIS continues to evolve, and now treatment strategies also include breast-conserving therapy, which consists of local excision
followed by radiation therapy or local excision alone. Multiple randomized trials have confirmed a decrease in ipsilateral
breast tumor recurrence in patients treated with local excision followed by radiation therapy compared with local excision
alone. Ongoing clinical trials attempt to identify a subgroup of DCIS patients at low risk for recurrence who may not benefit
from radiation therapy. In addition, because the majority of ipsilateral breast tumor recurrences occur near the original
primary tumor site, partial breast irradiation is currently under investigation as a treatment option for DCIS patients. Randomized
trials have shown tamoxifen can reduce the risk of ipsilateral and contralateral breast tumor recurrences while the role of
aromatase inhibitors is the subject of current clinical trials. DCIS represents a complex pathologic entity, and treatment
optimization requires a multidisciplinary approach. |
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