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ductal carcinoma in-situ (DCIS)

generally in reference to breast ductal carcinoma in situ Laboratory: - DCIS intraductal extension in breast cancer specimen - DCIS necrosis in breast cancer specimen - DCIS additional dimension in breast cancer specimen - DCIS maximum dimension in breast cancer specimen - growth pattern of DCIS in breast cancer specimen - surgical margin DCIS involvement in breast cancer - tissue blocks positive for DCIS Radiology: - followup annual mammography [3] Complications: - elevated risk for subsequent invasive breast cancer & breast cancer- related mortality (RR>2) [9,10] Management: 1) ductal carcinoma in situ, although not a life-threatening condition, is generally treated similarly to invasive breast cancer [5] - wide surgical excision followed by radiation therapy (MKSAP19) [3] - mastectomy of cancer cannot be completely removed (MKSAP19) [3] - watchful waiting with close observation is an option discussed in [7] 2) surgical excision - prognosis good after breast-conserving surgery [2] 3) radiotherapy may reduce risk of subsequent ipsilateral breast cancer 4) tamoxifen & aromatase inhibitors may reduce risk of subsequent breast cancer in estrogen receptor positive DCIS (either side) - does not confer survival benefit [3,4] - nontheless, treatment of choice (MKSAP19) [3] 5) editorialist suggests higher-grade tumors pose greatest risk of recurrence & radiotherapy or chemotherapy may be overtreatment of DCIS 6) lumpectomy with radiotherapy or mastectomy reduces risk for recurrence of invasive breast cancer at 10 years, but dues not reduce breast cancer-specific mortality [3,6] or overall 10-year mortality [3] - routine use of radiation therapy & extensive follow-up screening probably not cost-effective [6] 7) bilateral mastectomy eliminates benefit of radiotherapy or hormonal therapy [3] 8) avoiding the word 'cancer' in shared decision making discussions increases the likelihood a women will choose non-surgical intervention [4]

Related

ductal carcinoma, breast

General

carcinoma in situ breast cancer

References

  1. Physician's First Watch Massachusetts Medical Society http://www.jwatch.org - Cuzick J 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 Jan;12(1):21-9. Epub 2010 Dec 7. PMID: 21145284 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(10)70266-7/fulltext - Kuere HM Rational individualised selection of adjuvant therapy for ductal carcinoma in situ Lancet Oncol. 2011 Jan;12(1):2-3. Epub 2010 Dec 7. PMID: 21145285 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(10)70277-1/fulltext - Houghton J et al Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet. 2003 Jul 12;362(9378):95-102. PMID: 12867108
  2. Wapnir IL 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 Mar 16; 103:478 PMID: 21398619
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  4. Omer ZB et al Impact of Ductal Carcinoma In Situ Terminology on Patient Treatment Preferences. JAMA Intern Med. Augues 26, 2013 PMID: 23978843 http://archinte.jamanetwork.com/article.aspx?articleid=1731962
  5. Barratt A Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality. BMJ 2015;350:h867 PMID: 25736426 http://www.bmj.com/content/350/bmj.h867
  6. Narod SA et al Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. Published online August 20, 2015 PMID: 26291673 http://oncology.jamanetwork.com/article.aspx?articleid=2427491 - Esserman L, Yau C. Rethinking the Standard for Ductal Carcinoma In Situ Treatment. JAMA Oncol. Published online August 20, 2015 PMID: 26291410 http://oncology.jamanetwork.com/article.aspx?articleid=2427488
  7. Merrill Al, Esserman L, Morrow M Ductal Carcinoma In Situ. N Engl J Med 2016; 374:390-392. January 28, 2016 PMID: 26816018 http://www.nejm.org/doi/full/10.1056/NEJMclde1512213
  8. Margolese RG, Cecchini RS, Julian TB et al Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016 Feb 27;387(10021):849-56. PMID: 26686957 Free PMC Article
  9. Mannu GS, Wang Z, Broggio J et al Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study. BMJ 2020;369:m1570 PMID: 32461218 https://www.bmj.com/content/369/bmj.m1570
  10. Giannakeas V, Sopik V, Narod SA et al Association of a Diagnosis of Ductal Carcinoma In Situ With Death From Breast Cancer. JAMA Netw Open. 2020;3(9):e2017124 PMID: 32936299 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770653