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Is DCIS Overrated?

  • Joshua Feinberg
  • Rachel Wetstone
  • Dana Greenstein
  • Patrick BorgenEmail author
Chapter
Part of the Cancer Treatment and Research book series (CTAR, volume 173)

Abstract

Ductal carcinoma in situ (DCIS), the noninvasive form of breast cancer (BC), comprises just over 20% of breast cancer cases diagnosed each year in the USA. Most patients are treated with local excision of the disease followed by whole breast radiation therapy. Total mastectomy is not an uncommon approach, and total mastectomy with a contralateral risk-reducing mastectomy has been on the rise in the past decade. In estrogen receptor-positive disease, patients are often offered endocrine ablative therapy with a selective estrogen receptor modulator or an aromatase inhibitor as both treatment and prevention. Local regional treatment options have no impact upon ultimate overall survival. Long-term survival rates are higher in patients with DCIS than with any other form of the disease. Are these strikingly high success rates a testament to effective treatment strategies or is there a significant subset of DCIS that was unlikely to ever progress to invasive ductal carcinoma? DCIS was not seen in the US prior to the advent of screening mammography. When compared to other countries, the USA has the highest utilization of screening mammography and the incidence rate of DCIS. Other lines of evidence include autopsy series examining the breast tissue of women who died of other causes, missed-diagnosis series and current retrospective reviews of DCIS, all align in support of the concept of DCIS as indolent in the majority of cases [3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]. The evidence suggests that both patient and physician misconceptions about DCIS have led to overdiagnosis and over-treatment of DCIS. Recently, a gene expression profiling tool (12 gene assay, Oncotype DCIS) has emerged that shows considerable promise in predicting class in DCIS patients.

Keywords

Ductal carcinoma in situ DCIS Breast cancer Breast cancer screening Breast cancer genomic profiling 

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Joshua Feinberg
    • 1
  • Rachel Wetstone
    • 2
  • Dana Greenstein
    • 2
  • Patrick Borgen
    • 2
    Email author
  1. 1.Department of Surgery, Maimonides Breast Center, Maimonides Medical CenterResearch Fellow, Oxford UniversityOxfordEngland
  2. 2.Department of SurgeryMaimonides Medical CenterBrooklynUSA

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