scholarly journals ASO Author Reflections: Advising a Woman with Ductal Carcinoma In Situ Regarding Various Treatment Options—A Complex Decision

2019 ◽  
Vol 26 (13) ◽  
pp. 4272-4273
Author(s):  
Anita Mamtani ◽  
Kimberly J. Van Zee
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Complex Decision

scholarly journals Ductal Carcinoma In Situ of the Breast

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Richard J. Lee ◽  
Laura A. Vallow ◽  
Sarah A. McLaughlin ◽  
Katherine S. Tzou ◽  
Stephanie L. Hines ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Partial Breast Irradiation ◽  
Significant Shift

Ductal carcinoma in situ (DCIS) of the breast represents a complex, heterogeneous pathologic condition in which malignant epithelial cells are confined within the ducts of the breast without evidence of invasion. The increased use of screening mammography has led to a significant shift in the diagnosis of DCIS, accounting for approximately 27% of all newly diagnosed cases of breast cancer in 2011, with an overall increase in incidence. As the incidence of DCIS increases, the treatment options continue to evolve. Consistent pathologic evaluation is crucial in optimizing treatment recommendations. Surgical treatment options include breast-conserving surgery (BCS) and mastectomy. Postoperative radiation therapy in combination with breast-conserving surgery is considered the standard of care with demonstrated decrease in local recurrence with the addition of radiation therapy. The role of endocrine therapy is currently being evaluated. The optimization of diagnostic imaging, treatment with regard to pathological risk assessment, and the role of partial breast irradiation continue to evolve.

scholarly journals Ductal Carcinoma In Situ of the Breast: Should Breast Irradiation Be Routinely Added to Surgical Excision?

2016 ◽  
Vol 12 (4) ◽  
pp. 309-311 ◽  
Author(s):  
William C. Wood
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Genomic Analysis ◽  
Surgical Excision ◽  
Lesion Size ◽  
Medical Community ◽  
New Diagnosis

Confusion exists among women with a new diagnosis of ductal carcinoma in situ and their physicians regarding choice of treatment. The press has accused the medical community of overtreatment and found many physicians eager to support or deny the charge. Improvements in treatment delivery have been matched with better definitions of risk on the basis of biology as defined by genomic analysis rather than only lesion size, margins, receptor status, and patient age. Understanding both the risk of a specific ductal carcinoma in situ progressing to invasive breast cancer and the risks of the treatment options allows tailored recommendations.

scholarly journals Ductal Carcinoma in Situ (DCIS)

2017 ◽  
Author(s):  
Patricia A Cronin ◽  
Kimberly J Van Zee
Keyword(s):  
Endocrine Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Breast Conservation ◽  
The United States ◽  
Intraductal Carcinoma ◽  
Bilateral Mastectomy

Ductal carcinoma in situ (DCIS) is noninvasive intraductal carcinoma of the breast and is defined as a malignant proliferation of ductal epithelial cells that are confined to the milk ducts. It is a nonobligate precursor of invasive breast cancer, but at present, there is no reliable method of predicting which lesions will invade in a given time frame. Historically, DCIS was an uncommon lesion; however, widespread use of screening mammography has resulted in a significant increase in the rate of detection, and DCIS now accounts for about 20% of all breast cancers in the United States. Current treatment options for DCIS include breast-conserving surgery (BCS) alone, BCS with radiotherapy (RT), BCS with endocrine therapy, BCS with both RT and endocrine therapy, mastectomy, and even bilateral mastectomy. There is currently concern about overtreatment of this lesion, but there are no reliable data regarding outcomes without treatment. Although survival is excellent with all standard treatments, local recurrence rates vary widely with various treatment options. Given the variety of options available, the goal of treatment is to tailor the management plan to the individual and optimize the balance of risks and benefits according to the values and priorities of the woman herself. This review contains 10 figures, 6 tables and 54 references.  Key words: active surveillance, breast conservation, ductal carcinoma in situ, endocrine therapy, intraductal carcinoma, margins, mastectomy, radiation, recurrence, risk factors  

Nomogram for Predicting the Risk of Local Recurrence After Breast-Conserving Surgery for Ductal Carcinoma In Situ

2010 ◽  
Vol 28 (23) ◽  
pp. 3762-3769 ◽  
Author(s):  
Udo Rudloff ◽  
Lindsay M. Jacks ◽  
Jessica I. Goldberg ◽  
Christine A. Wynveen ◽  
Edi Brogi ◽  
...  
Keyword(s):  
Decision Making ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Proportional Hazards Model ◽  
Treatment Time ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Cox Proportional Hazards Model

Purpose While the mortality associated with ductal carcinoma in situ (DCIS) is minimal, the risk of ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) is relatively high. Radiation therapy (RT) and antiestrogen agents reduce the risk of IBTR and are considered standard treatment options after BCS. However, they have never been proven to improve survival, and in themselves carry rare but serious risks. Individualized estimation of IBTR risk would assist in decision making regarding the various treatment options for women with DCIS. Patients and Methods From 1991 to 2006, 1,868 consecutive patients treated with BCS for DCIS were identified. A multivariate Cox proportional hazards model was constructed using the 1,681 in whom data were complete. Ten clinical, pathologic, and treatment variables were built into a nomogram estimating probability of IBTR at 5 and 10 years after BCS. The model was validated for discrimination and calibration using bootstrap resampling. Results The DCIS nomogram for prediction of 5- and 10-year IBTR probabilities demonstrated good calibration and discrimination, with a concordance index of 0.704 (bootstrap corrected, 0.688) and a concordance probability estimate of 0.686. Factors with the greatest influence on risk of IBTR in the model included adjuvant RT or endocrine therapy, age, margin status, number of excisions, and treatment time period. Conclusion The DCIS nomogram integrates 10 clinicopathologic variables to provide an individualized risk estimate of IBTR in a woman with DCIS treated with BCS. This tool may assist in individual decision making regarding various treatment options and help avoid over- and undertreatment of noninvasive breast cancer.

scholarly journals Ductal Carcinoma in Situ (DCIS)

2017 ◽  
Author(s):  
Patricia A Cronin ◽  
Kimberly J Van Zee
Keyword(s):  
Endocrine Therapy ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Treatment Options ◽  
Breast Conservation ◽  
The United States ◽  
Intraductal Carcinoma ◽  
Bilateral Mastectomy

Ductal carcinoma in situ (DCIS) is noninvasive intraductal carcinoma of the breast and is defined as a malignant proliferation of ductal epithelial cells that are confined to the milk ducts. It is a nonobligate precursor of invasive breast cancer, but at present, there is no reliable method of predicting which lesions will invade in a given time frame. Historically, DCIS was an uncommon lesion; however, widespread use of screening mammography has resulted in a significant increase in the rate of detection, and DCIS now accounts for about 20% of all breast cancers in the United States. Current treatment options for DCIS include breast-conserving surgery (BCS) alone, BCS with radiotherapy (RT), BCS with endocrine therapy, BCS with both RT and endocrine therapy, mastectomy, and even bilateral mastectomy. There is currently concern about overtreatment of this lesion, but there are no reliable data regarding outcomes without treatment. Although survival is excellent with all standard treatments, local recurrence rates vary widely with various treatment options. Given the variety of options available, the goal of treatment is to tailor the management plan to the individual and optimize the balance of risks and benefits according to the values and priorities of the woman herself. This review contains 10 figures, 6 tables and 54 references.  Key words: active surveillance, breast conservation, ductal carcinoma in situ, endocrine therapy, intraductal carcinoma, margins, mastectomy, radiation, recurrence, risk factors  

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