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Ductal Carcinoma In Situ Management: All or Nothing, or Something in between?

  • Local-Regional Evaluation and Therapy (DM Euhus, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Standard treatment for ductal carcinoma in situ (DCIS) is similar to that of invasive carcinoma. However, there is significant controversy regarding the true clinical implications of DCIS, and thus, the best management strategy. The aim of this review is to highlight relevant biology, diagnostic considerations, treatment options, and recent clinical trials.

Recent Findings

Outcomes are generally excellent with low recurrence rates and exceptional disease-specific survival. Outcomes can be predicted using various prognostic indicators and/or nomograms to guide treatment decisions. Ongoing clinical trials of active surveillance are based upon the argument that ipsilateral invasive recurrence is the most clinically meaningful endpoint. These trials seek to compare ipsilateral invasive cancer diagnoses between standard of care and close monitoring.

Summary

Recent trials have revealed the marked heterogeneity in the biology of DCIS, offering an opportunity to de-escalate therapy for women at lowest risk for progression. DCIS also presents an ideal setting in which to test novel prevention agents. Future care of patients with DCIS will include biomarker-based risk assessment in order to better individualize treatment to biologic risk of invasive progression.

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Acknowledgements

We would like to acknowledge and thank Lauren Halligan for her contributions in preparation of the figure for this manuscript.

Funding Sources

ESH is supported by the NIH (RFA-CA-17-035, R01 CA185138-01), the DOD (BC132057), PCORI (1505-30497, 1503-29572) and BCRF, as well as by the Duke Cancer Support Grant (5P30CA014236-44). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

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  1. Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC, 27710, USA

    Jennifer K. Plichta, Laura H. Rosenberger, Cosette A. DeChant & E. Shelley Hwang

  2. Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA

    Jennifer K. Plichta, Laura H. Rosenberger & E. Shelley Hwang

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Plichta, J.K., Rosenberger, L.H., DeChant, C.A. et al. Ductal Carcinoma In Situ Management: All or Nothing, or Something in between?. Curr Breast Cancer Rep 11, 190–202 (2019). https://doi.org/10.1007/s12609-019-0306-2

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