Ductal Carcinoma In Situ Biology, Language, and Active Surveillance: A Survey of Breast Radiologists’ Knowledge and Opinions

Abstract

Purpose: To understand how breast radiologists perceive ductal carcinoma in situ (DCIS). Materials and methods:A 19-item survey was developed by the Society of Breast Imaging Patient Care and Delivery Committee and distributed to all SBI members. The survey queried respondents' demographics, knowledge of DCIS biology, language used to discuss a new diagnosis of DCIS, and perspectives on active surveillance for DCIS. Five-point Likert scales (1=strongly disagree, 3=neutral, 5=strongly agree) were used.Results: There were 536 responses for a response rate of 41%. There was agreement that DCIS is the primary driver of overdiagnosis in breast cancer screening (median 4) and respondents provided mean and median overdiagnosis estimates of 29.7% and 25% for low-grade DCIS as well as 4.2% and 0% for high-grade DCIS respectively. Respondents were varied in how they describe DCIS but most often use the word 'cancer' with a qualifier such as early (32%) or pre-invasive (25%). Respondents disagreed (median 2) with removing the word 'carcinoma' from DCIS. Finally, there was agreement that current standard of care therapy for some forms of DCIS is overtreatment (median 4) and that active surveillance as an alternative management strategy should be studied (mean 4), but felt that US (median 4) and MRI (median 4) should be used to exclude women with occult invasive disease prior to active surveillance.

Ductal carcinoma in situ of the male breast: clinical radiological features and management in a cancer referral center

“…In this article, based on our experience, we aim to provide an appropriate diagnostic and therapeutic approach for this rare condition. Radiological, histological, and clinical features in male DCIS differ from DCIS in women, and for adequate management, the knowledge of two different forms of the same pathology appears extremely important [ 17 , 18 , 19 , 20 , 21 ]. In our series, pure DCIS was observed in 21/233 cases (9.0%).…”

Ductal Carcinoma in Situ: State-of-the-Art Review

“…D uctal carcinoma in situ (DCIS) exists at the border between benign breast disease and malignant cancer, resulting in notable challenges in detection, diagnosis, and management. Pathologists have variability in their diagnosis of DCIS, radiologists differ in how they describe DCIS to patients, and there are ongoing efforts aimed at renaming DCIS (1)(2)(3). As the incidence of DCIS increased with the introduction of organized breast cancer screening starting in the 1980s, an awareness of DCIS as a major driver of overdiagnosis and overtreatment in breast cancer screening programs has grown (4).…”