Current Breast Cancer Reports

, Volume 5, Issue 2, pp 86–98

New Treatment Paradigms for Patients with Ductal Carcinoma In Situ

Local-Regional Evaluation and Therapy (KK Hunt, Section Editor)


One of the most poorly understood clinical diagnoses in breast cancer is ductal carcinoma in situ (DCIS), which now accounts for almost one third of all mammographically detected malignancies. Detection and diagnosis of DCIS have improved, and mature data from randomized controlled trials of lumpectomy for DCIS have provided some measure of the magnitude of benefit to be derived from adjuvant treatments. The past 5 years have seen the emergence of molecular prognostic tools, which together with clinical factors have the potential to allow better selection of individualized therapies for these heterogeneous lesions. Ongoing and future research to identify which patients with DCIS can be safely managed with active surveillance are underway and will create opportunities to better understand the biology of this disease, thereby informing treatment strategies that are more closely aligned with the invasive potential of specific DCIS subtypes.


Ductal carcinoma in situ DCIS Breast cancer Mammography MRI Mastectomy Lumpectomy Radiation Sentinel lymph node biopsy Systemic therapy Prognosis Biomarkers Preoperative hormone therapy Her-2 directed therapies Active surveillance 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Sumner 3rd WE, Koniaris LG, Snell SE, Spector S, Powell J, Avisar E, et al. Results of 23,810 cases of ductal carcinoma-in-situ. Ann Surg Oncol. 2007;14:1638–43.PubMedCrossRefGoogle Scholar
  2. 2.
    Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96:443–8.PubMedCrossRefGoogle Scholar
  3. 3.
    • Ozanne EM, Shieh Y, Barnes J, Bouzan C, Hwang ES, Esserman LJ. Characterizing the impact of 25 years of DCIS treatment. Breast Cancer Res Treat. 2011;129:165–73. Epidemiologic modeling of the projected benefit of treating DCIS and preventing its diagnosis as invasive cancer.PubMedCrossRefGoogle Scholar
  4. 4.
    Ma XJ, Salunga R, Tuggle JT, Gaudet J, Enright E, McQuary P, et al. Gene expression profiles of human breast cancer progression. Proc Natl Acad Sci U S A. 2003;100:5974–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Warnberg F, Nordgren H, Bergkvist L, Holmberg L. Tumour markers in breast carcinoma correlate with grade rather than with invasiveness. Br J Cancer. 2001;85:869–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Hwang ES, DeVries S, Chew KL, Moore 2nd DH, Kerlikowske K, Thor A, et al. Patterns of chromosomal alterations in breast ductal carcinoma in situ. Clin Cancer Res. 2004;10:5160–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Ikeda DM, Andersson I. Ductal carcinoma in situ: atypical mammographic appearances. Radiology. 1989;172:661–6.PubMedGoogle Scholar
  8. 8.
    Stomper PC, Connolly JL, Meyer JE, Harris JR. Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation. Radiology. 1989;172:235–41.PubMedGoogle Scholar
  9. 9.
    Esserman LJ, Kumar AS, Herrera AF, Leung J, Au A, Chen YY, et al. Magnetic resonance imaging captures the biology of ductal carcinoma in situ. J Clin Oncol. 2006;24:4603–10.PubMedCrossRefGoogle Scholar
  10. 10.
    • Holmberg L, Wong YN, Tabar L, Ringberg A, Karlsson P, Arnesson LG, et al. Mammography casting-type calcification and risk of local recurrence in DCIS: analyses from a randomised study. Br J Cancer. 2013;108:812–9. Suggests that morphologic characterstics of DCIS calcifications may have prognostic value.Google Scholar
  11. 11.
    Del Turco MR, Mantellini P, Ciatto S, Bonardi R, Martinelli F, Lazzari B, et al. Full-field digital vs screen-film mammography: comparative accuracy in concurrent screening cohorts. Am J Roentgenol. 2007;189:860–6.Google Scholar
  12. 12.
    Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, et al. Diagnostic performance of digital vs film mammography for breast-cancer screening. N Engl J Med. 2005;353:1773–83.Google Scholar
  13. 13.
    • Bluekens AM, Holland R, Karssemeijer N, Broeders MJ, den Heeten GJ. Comparison of digital screening mammography and screen-film mammography in the early detection of clinically relevant cancers: a multicenter study. Radiology. 2012;265:707–14. Recent study comparing digital and screen field mammography for DCIS and early stage invasive cancers.Google Scholar
  14. 14.
    Holland R, Hendriks JH, Vebeek AL, Mravunac M, Schuurmans Stekhoven JH. Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet. 1990;335:519–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Silverstein MJ, Lagios MD, Recht A, Allred DC, Harms SE, Holland R, et al. Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg. 2005;201:586–97.PubMedCrossRefGoogle Scholar
  16. 16.
    Liberman L. Clinical management issues in percutaneous core breast biopsy. Radiol Clin North Am. 2000;38:791–807.PubMedCrossRefGoogle Scholar
  17. 17.
    Ciatto S, Houssami N, Ambrogetti D, Bianchi S, Bonardi R, Brancato B, et al. Accuracy and underestimation of malignancy of breast core needle biopsy: the Florence experience of over 4000 consecutive biopsies. Breast Cancer Res Treat. 2007;101:291–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Darling ML, Smith DN, Lester SC, Kaelin C, Selland DL, Denison CM, et al. Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision. Am J Roentgenol. 2000;175:1341–6.Google Scholar
  19. 19.
    Hwang ES, Kinkel K, Esserman LJ, Lu Y, Weidner N, Hylton NM. Magnetic resonance imaging in patients diagnosed with ductal carcinoma-in-situ: value in the diagnosis of residual disease, occult invasion, and multicentricity. Ann Surg Oncol. 2003;10:381–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Menell JH, Morris EA, Dershaw DD, Abramson AF, Brogi E, Liberman L. Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J. 2005;11:382–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Santamaria G, Velasco M, Farrus B, Zanon G, Fernandez PL. Preoperative MRI of pure intraductal breast carcinoma–a valuable adjunct to mammography in assessing cancer extent. Breast. 2008;17:186–94.PubMedCrossRefGoogle Scholar
  22. 22.
    Schouten van der Velden AP, Boetes C, Bult P, Wobbes T. The value of magnetic resonance imaging in diagnosis and size assessment of in situ and small invasive breast carcinoma. Am J Surg. 2006;192:172–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Allen LR, Lago-Toro CE, Hughes JH, Careaga E, Brown AT, Chernick M, et al. Is there a role for MRI in the preoperative assessment of patients with DCIS? Ann Surg Oncol. 2010;17:2395–400.PubMedCrossRefGoogle Scholar
  24. 24.
    • Itakura K, Lessing J, Sakata T, Heinzerling A, Vriens E, Wisner D, et al. The impact of preoperative magnetic resonance imaging on surgical treatment and outcomes for ductal carcinoma in situ. Clin Breast Cancer. 2011;11:33–8. Recent study analyzing the impact of MRI on surgical outcomes for DCIS.PubMedCrossRefGoogle Scholar
  25. 25.
    • Davis KL, Barth Jr RJ, Gui J, Dann E, Eisenberg B, Rosenkranz K. Use of MRI in preoperative planning for women with newly diagnosed DCIS: risk or benefit? Ann Surg Oncol. 2012;19:3270–4. Indicates no clinical benefit to MRI as part of preoperative work-up for DCIS.PubMedCrossRefGoogle Scholar
  26. 26.
    Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 2007;356:1295–303.PubMedCrossRefGoogle Scholar
  27. 27.
    •• Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102:170–8. Excellent systematic review commissioned by the NIH of 374 publications of DCIS and outcomes in women.PubMedCrossRefGoogle Scholar
  28. 28.
    Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27:1362–7.Google Scholar
  29. 29.
    Schnitt SJ, Connolly JL, Tavassoli FA, Fechner RE, Kempson RL, Gelman R, et al. Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria. Am J Surg Pathol. 1992;16:1133–43.PubMedCrossRefGoogle Scholar
  30. 30.
    Holland R, Peterse JL, Millis RR, Eusebi V, Faverly D, van de Vijver MJ, et al. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol. 1994;11:167–80.PubMedGoogle Scholar
  31. 31.
    Faverly DR, Burgers L, Bult P, Holland R. Three dimensional imaging of mammary ductal carcinoma in situ: clinical implications. Semin Diagn Pathol. 1994;11:193–8.PubMedGoogle Scholar
  32. 32.
    Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260:119–28.PubMedCrossRefGoogle Scholar
  33. 33.
    Kettritz U, Rotter K, Schreer I, Murauer M, Schulz-Wendtland R, Peter D, et al. Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer. 2004;100:245–51.PubMedCrossRefGoogle Scholar
  34. 34.
    Houssami N, Ciatto S, Ellis I, Ambrogetti D. Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer. 2007;109:487–95.PubMedCrossRefGoogle Scholar
  35. 35.
    • Gomez SL, Lichtensztajn D, Kurian AW, Telli ML, Chang ET, Keegan TH, et al. Increasing mastectomy rates for early-stage breast cancer? Population-based trends from California. J Clin Oncol. 2010;28:e155–7. author reply e158. Short report describing which patient subgroups are most likely to opt for mastectomy.PubMedCrossRefGoogle Scholar
  36. 36.
    Hwang ES. The impact of surgery on ductal carcinoma in situ outcomes: the use of mastectomy. J Natl Cancer Inst Monogr. 2010;2010:197–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Crowe JP, Patrick RJ, Yetman RJ, Djohan R. Nipple-sparing mastectomy update: 149 procedures and clinical outcomes. Arch Surg. 2008;143:1106–10. discussion 10.Google Scholar
  38. 38.
    • Sakurai T, Zhang N, Suzuma T, Umemura T, Yoshimura G, Yang Q. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution. Med Oncol. 2013;30:481. Good review of a single institution experience with nipple-sparing mastectomy.PubMedCrossRefGoogle Scholar
  39. 39.
    Warren Peled A, Foster RD, Stover AC, Itakura K, Ewing CA, Alvarado M, et al. Outcomes after total skin-sparing mastectomy and immediate reconstruction in 657 breasts. Ann Surg Oncol. 2012;19:3402–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Wagner JL, Fearmonti R, Hunt KK, Hwang RF, Meric-Bernstam F, Kuerer HM, et al. Prospective evaluation of the nipple-areola complex sparing mastectomy for risk reduction and for early-stage breast cancer. Ann Surg Oncol. 2012;19:1137–44.PubMedCrossRefGoogle Scholar
  41. 41.
    Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol. 1998;16:441–52.PubMedGoogle Scholar
  42. 42.
    Lee LA, Silverstein MJ, Chung CT, Macdonald H, Sanghavi P, Epstein M, et al. Breast cancer-specific mortality after invasive local recurrence in patients with ductal carcinoma-in-situ of the breast. Am J Surg. 2006;192:416–9.PubMedCrossRefGoogle Scholar
  43. 43.
    •• Correa C, McGale P, Taylor C, Wang Y, Clarke M, Davies C, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010;2010:162–77. Comprehensive summary of the prospective randomized trials of adjuvant radiation in DCIS.Google Scholar
  44. 44.
    Bijker N, Meijnen P, Peterse JL, Bogaerts J, Van Hoorebeeck I, Julien JP, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853–a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24:3381–7.PubMedCrossRefGoogle Scholar
  45. 45.
    •• Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 2011;12:21–9. Long-term results from the UK/ANZ DCIS trial demonstrating significant benefit with radiation and tamoxifen.PubMedCrossRefGoogle Scholar
  46. 46.
    Holmberg L, Garmo H, Granstrand B, Ringberg A, Arnesson LG, Sandelin K, et al. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol. 2008;26:1247–52.PubMedCrossRefGoogle Scholar
  47. 47.
    • Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103:478–88. Study evaluating long-term outcomes from B-17 and B-24 that demonstrates increased mortality in women who recur with invasive cancer following treatment for DCIS.PubMedCrossRefGoogle Scholar
  48. 48.
    Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.PubMedCrossRefGoogle Scholar
  49. 49.
    • Vicini F, Shah C, Ben Wilkinson J, Keisch M, Beitsch P, Lyden M. Should ductal carcinoma-in-situ (DCIS) be removed from the ASTRO Consensus Panel Cautionary Group for off-protocol use of accelerated partial breast irradiation (APBI)? A pooled analysis of outcomes for 300 patients with DCIS treated with APBI. Ann Surg Oncol. 2013;20:1275–81. Discussion of the appropriate use of APBI for DCIS.Google Scholar
  50. 50.
    Benitez PR, Streeter O, Vicini F, Mehta V, Quiet C, Kuske R, et al. Preliminary results and evaluation of MammoSite balloon brachytherapy for partial breast irradiation for pure ductal carcinoma in situ: a phase II clinical study. Am J Surg. 2006;192:427–33.PubMedCrossRefGoogle Scholar
  51. 51.
    Asgeirsson KS, Rasheed T, McCulley SJ, Macmillan RD. Oncological and cosmetic outcomes of oncoplastic breast conserving surgery. Eur J Surg Oncol. 2005;31:817–23.PubMedCrossRefGoogle Scholar
  52. 52.
    Losken A, Schaefer TG, Newell M, Styblo TM. The impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance. Plast Reconstr Surg. 2009;124:9–17.PubMedCrossRefGoogle Scholar
  53. 53.
    • Song HM, Styblo TM, Carlson GW, Losken A. The use of oncoplastic reduction techniques to reconstruct partial mastectomy defects in women with ductal carcinoma in situ. Breast J. 2010;16:141–6. Specifically presents the indications and outcomes of oncoplastic surgery for DCIS.PubMedCrossRefGoogle Scholar
  54. 54.
    Wong JS, Kaelin CM, Troyan SL, Gadd MA, Gelman R, Lester SC, et al. Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol. 2006;24:1031–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Hughes LL, Wang M, Page DL, Gray R, Solin LJ, Davidson NE, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27:5319–24.PubMedCrossRefGoogle Scholar
  56. 56.
    • McCormick B, Winter K, Hudis C, Kuerer HM, Rakovitch E, Smith BL, et al. RTOG 9804: a prospective randomized trial for "good risk" ductal carinoma in situ (DCIS) comparing radiation to observation. ASCO. May 2012. Unpublished randomized trial of radiation vs no radiation following lumpectomy for low risk DCIS.Google Scholar
  57. 57.
    Frykberg ER, Masood S, Copeland 3rd EM, Bland KI. Ductal carcinoma in situ of the breast. Surg Gynecol Obstet. 1993;177:425–40.PubMedGoogle Scholar
  58. 58.
    Lagios MD, Westdahl PR, Margolin FR, Rose MR. Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer. 1982;50:1309–14.PubMedCrossRefGoogle Scholar
  59. 59.
    Silverstein MJ, Rosser RJ, Gierson ED, Waisman JR, Gamagami P, Hoffman RS, et al. Axillary lymph node dissection for intraductal breast carcinoma–is it indicated? Cancer. 1987;59:1819–24.PubMedCrossRefGoogle Scholar
  60. 60.
    Murphy CD, Jones JL, Javid SH, Michaelson JS, Nolan ME, Lipsitz SR, et al. Do sentinel node micrometastases predict recurrence risk in ductal carcinoma in situ and ductal carcinoma in situ with microinvasion? Am J Surg. 2008;196:566–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Lara JF, Young SM, Velilla RE, Santoro EJ, Templeton SF. The relevance of occult axillary micrometastasis in ductal carcinoma in situ: a clinicopathologic study with long-term follow-up. Cancer. 2003;98:2105–13.PubMedCrossRefGoogle Scholar
  62. 62.
    Moore KH, Sweeney KJ, Wilson ME, Goldberg JI, Buchanan CL, Tan LK, et al. Outcomes for women with ductal carcinoma-in-situ and a positive sentinel node: a multi-institutional audit. Ann Surg Oncol. 2007;14:2911–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER, Mamounas E, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomized controlled trial. Lancet. 1999;353:1993–2000.Google Scholar
  64. 64.
    •• Allred DC, Anderson SJ, Paik S, Wickerham DL, Nagtegaal ID, Swain SM, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol. 2012;30:1268–73. Results of the efficacy of tamoxifen for both ER-positive and ER-negative disease.PubMedCrossRefGoogle Scholar
  65. 65.
    •• Goss PE, Ingle JN, Ales-Martinez JE, Cheung AM, Chlebowski RT, Wactawski-Wende J, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011;364:2381–91. Prevention study of aromatase inhibitors which has potential implications for DCIS adjuvant hormonal therapy.PubMedCrossRefGoogle Scholar
  66. 66.
    Roses RE, Paulson EC, Sharma A, Schueller JE, Nisenbaum H, Weinstein S, et al. HER-2/neu overexpression as a predictor for the transition from in situ to invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2009;18:1386–9.PubMedCrossRefGoogle Scholar
  67. 67.
    • Kuerer HM, Buzdar AU, Mittendorf EA, Esteva FJ, Lucci A, Vence LM, et al. Biologic and immunologic effects of preoperative trastuzumab for ductal carcinoma in situ of the breast. Cancer. 2011;117:39–47. Window trial of preoperative trastuzumab for Her2(+) DCIS.PubMedCrossRefGoogle Scholar
  68. 68.
    NSABP B-43. A phase III trial comparing trastuzumab given concurrently with radiation therapy and radiation therapy alone for women with HER-2-positive DCIS resected by lumpectomy.
  69. 69.
    Silverstein MJ, Poller DN, Waisman JR, Colburn WJ, Barth A, Gierson ED, et al. Prognostic classification of breast ductal carcinoma-in-situ. Lancet. 1995;345:1154–7.PubMedCrossRefGoogle Scholar
  70. 70.
    • Silverstein MJ, Lagios MD. Choosing treatment for patients with ductal carcinoma in situ: fine tuning the University of Southern California/Van Nuys Prognostic Index. J Natl Cancer Inst Monogr. 2010:2010;193–6. Updated evaluation of the VNPI scoring system with over 900 patients and outcomes stratified by VNPI score.Google Scholar
  71. 71.
    • Rudloff U, Jacks LM, Goldberg JI, Wynveen CA, Brogi E, Patil S, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010;28:3762–9. Important presentation of a clinical nomogram to predict recurrence risk given a set of clinical and pathologic parameters.Google Scholar
  72. 72.
    • Yi M, Meric-Bernstam F, Kuerer HM, Mittendorf EA, Bedrosian I, Lucci A, et al. Evaluation of a breast cancer nomogram for predicting risk of ipsilateral breast tumor recurrences in patients with ductal carcinoma in situ after local excision. J Clin Oncol. 2012;30:600–7. Interesting validation of the MSKCC DCIS nomogram in an independent dataset.Google Scholar
  73. 73.
    Kerlikowske K, Molinaro A, Cha I, Ljung BM, Ernster VL, Stewart K, et al. Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy. J Natl Cancer Inst. 2003;95:1692–702.PubMedCrossRefGoogle Scholar
  74. 74.
    Roka S, Rudas M, Taucher S, Dubsky P, Bachleitner-Hofmann T, Kandioler D, et al. High nuclear grade and negative estrogen receptor are significant risk factors for recurrence in DCIS. Eur J Surg Oncol. 2004;30:243–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Cornfield DB, Palazzo JP, Schwartz GF, Goonewardene SA, Kovatich AJ, Chervoneva I, et al. The prognostic significance of multiple morphologic features and biologic markers in ductal carcinoma in situ of the breast: a study of a large cohort of patients treated with surgery alone. Cancer. 2004;100:2317–27.PubMedCrossRefGoogle Scholar
  76. 76.
    Provenzano E, Hopper JL, Giles GG, Marr G, Venter DJ, Armes JE. Biological markers that predict clinical recurrence in ductal carcinoma in situ of the breast. Eur J Cancer. 2003;39:622–30.PubMedCrossRefGoogle Scholar
  77. 77.
    Zhou W, Jirstrom K, Johansson C, Amini RM, Blomqvist C, Agbaje O, et al. Long-term survival of women with basal-like ductal carcinoma in situ of the breast: a population-based cohort study. BMC Cancer. 2010;10:653.PubMedCrossRefGoogle Scholar
  78. 78.
    Rakovitch E, Nofech-Mozes S, Hanna W, Narod S, Thiruchelvam D, Saskin R, et al. HER2/neu and Ki-67 expression predict non-invasive recurrence following breast-conserving therapy for ductal carcinoma in situ. Br J Cancer. 2012;106:1160–5.PubMedCrossRefGoogle Scholar
  79. 79.
    Holmes P, Lloyd J, Chervoneva I, Pequinot E, Cornfield DB, Schwartz GF, et al. Prognostic markers and long-term outcomes in ductal carcinoma in situ of the breast treated with excision alone. Cancer. 2011;117:3650–7.PubMedCrossRefGoogle Scholar
  80. 80.
    •• Kerlikowske K, Molinaro AM, Gauthier ML, Berman HK, Waldman F, Bennington J, et al. Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. J Natl Cancer Inst. 2010;102:627–37. Novel molecular predictors of any recurrence and invasive recurrence for DCIS treated with surgery only.PubMedCrossRefGoogle Scholar
  81. 81.
    Tsikitis VL, Chung MA. Biology of ductal carcinoma in situ classification based on biologic potential. Am J Clin Oncol. 2006;29:305–10.PubMedCrossRefGoogle Scholar
  82. 82.
    Adler EH, Sunkara JL, Patchefsky AS, Koss LG, Oktay MH. Predictors of disease progression in ductal carcinoma in situ of the breast and vascular patterns. Hum Pathol. 2012;43:550–6.PubMedCrossRefGoogle Scholar
  83. 83.
    •• Solin LJ, Gray R, Baehner FL, Butler S, Badve S, Yoshizawa C, et al. A quantitative multigene RT-PCR assay for predicting recurrence risk after surgical excision alone without irradiation for ductal carcinoma in situ (DCIS): a prospective validation study of the DCIS Score from ECOG 5194. . San Antonio Breast Cancer Symposium 2011. 2011;Abstract S4–6. Unpublished study of the utility of the DCIS score for stratifying risk after lumpectomy alone for low risk DCIS.Google Scholar
  84. 84.
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.PubMedCrossRefGoogle Scholar
  85. 85.
    Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295:2727–41.PubMedCrossRefGoogle Scholar
  86. 86.
    • Chen YY, DeVries S, Anderson J, Lessing J, Swain R, Chin K, et al. Pathologic and biologic response to preoperative endocrine therapy in patients with ER-positive ductal carcinoma in situ. BMC Cancer. 2009;9:285. Neoadjuvant trial of hormone therapy in unresected DCIS showing change in morphology and biomarkers with endocrine treatment.Google Scholar
  87. 87.
    • Sharma A, Koldovsky U, Xu S, Mick R, Roses R, Fitzpatrick E, et al. HER-2 pulsed dendritic cell vaccine can eliminate HER-2 expression and impact ductal carcinoma in situ. Cancer. 2012;118:4354–62. Novel early study of a novel Her2-directed dendritic cell vaccine for her2(+) DCIS.Google Scholar
  88. 88.
    Meyerson AF, Lessing JN, Itakura K, Hylton NM, Wolverton DE, Joe BN, et al. Outcome of long-term active surveillance for estrogen receptor-positive ductal carcinoma in situ. Breast. 2011;20:529–33.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Aimee Mackey
    • 1
  • Rachel Greenup
    • 1
  • E. Shelley Hwang
    • 1
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations