Current Management of Ductal Carcinoma in situ (DCIS)

Abstract

Ductal carcinoma in situ (DCIS) is a non-invasive malignancy that develops within the breast ductal system's basement membrane. The natural history of DCIS is highly variable, with an estimated incidence of progression to invasive ductal carcinoma ranging from 20% to 53% ten years or more after the first diagnosis. DCIS surgical and adjuvant management has come a long way in the previous two decades. Despite this, surgeons, medical oncologists, and radiation oncologists, as well as their patients, continue to make management decisions based on traditional clinical and pathologic risk factors. The concurrence of DCIS and invasive carcinoma within one lesion suggests that DCIS is a precursor lesion to invasive carcinoma.  Long-term survival is great regardless of management method. The issue regarding DCIS revolves around avoiding either under- or over-treatment.   The objective of this chapter is to review the incidence and management options of DCIS. We will look at some of the current debates surrounding DCIS care, such as breast conserving surgery, the role of radiation in breast conserving surgery, sentinel node biopsy in DCIS, hormone therapy, risk classification, and the option of active surveillance for low-risk DCIS.