Annals of Surgical Oncology

, Volume 11, Supplement 1, pp 28S–36S

Applying the neoadjuvant paradigm to ductal carcinoma in situ

  • Laura Esserman
  • Karen Sepucha
  • Elissa Ozanne
  • E. Shelley Hwang
Article

DOI: 10.1007/BF02524793

Cite this article as:
Esserman, L., Sepucha, K., Ozanne, E. et al. Annals of Surgical Oncology (2004) 11(Suppl 1): 28S. doi:10.1007/BF02524793

Abstract

Local treatment options for ductal carcinoma in situ (DCIS) are virtually identical to those for early invasive breast cancer, despite the fact that the survival from this condition is much higher. Our ability to more appropriately tailor therapy for DCIS is hampered by a lack of understanding of the natural history of DCIS, our limited ability to predict the rate of progression to invasive cancer and the response to therapy, and the absence of tools to follow patients who have not had invasive treatments. Neoadjuvant therapy, which has been proven to be both safe and effective in tailoring treatments for invasive cancer, could be ideally suited to DCIS. However, neoadjuvant therapy requires that doctors and patients delay surgical treatment that has known benefits. In order to successfully introduce this approach into clinical practice, risk assessment and decision support tools will be needed to help physicians and patients feel comfortable that they are not being exposed to unnecessary or excessive risk. In addition, we need better imaging to track extent and progression of disease. Among the possible benefits of the neoadjuvant approach, we may discover that many lesions are responsive and some even reversible, leaving us with treatments that might be tailored to biology and with important clues for breast cancer prevention in high-risk women.

Key Words

DCIS Magnetic resonance imaging Risk assessment Biomarkers 

Copyright information

© The Society of Surgical Oncology, Inc 2003

Authors and Affiliations

  • Laura Esserman
    • 3
  • Karen Sepucha
    • 1
  • Elissa Ozanne
    • 2
  • E. Shelley Hwang
    • 3
  1. 1.Health Decisions Research UnitMassachusetts General HospitalBoston
  2. 2.Institute for Technology AssessmentMassachusetts General HospitalBoston
  3. 3.University of California San Francisco Medical CenterCarol Franc Buck Breast Care CenterSan Francisco