Ductal Carcinoma In Situ of the Breast

Abstract

Ductal carcinoma in-situ (DCIS) of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with DCIS include mastectomy or breast-conserving therapy (BCT). While several randomized trials have confirmed a greater than 50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared to breast-conserving surgery (BCS) alone, controversy persists regarding whether or not RT is needed in selected ‘low-risk’ patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery alone is associated with higher rates of local recurrence even after selecting patients with the most optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in these low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead employing more modern approaches such as multi-gene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multi-gene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of radiation therapy.

Local delivery of hormonal therapy with silastic tubing for prevention and treatment of breast cancer

“…Our data support the use of silastic tubing as an implanted device in three major applications: early interventions for localized tumors, such as ductal carcinoma in situ (DCIS) or early stage breast cancer with low metastatic potential, prevention of breast cancer in women at high risk for breast cancer due genetic or hereditary predisposition, or used in concert with systemic therapy to provide a localized therapeutic boost. The current standard of care in the management of patients with DCIS is breast conservation surgery followed by adjuvant radiation therapy 19 and systemic tamoxifen to reduce the risk for further disease in the same or contralateral breast 20 – 22 . Undesirable side effects and long-term sequelae, like strokes and endometrial cancer, unfortunately result in compliance rates as low as 50% 11 , 23 .…”

Quality of life in early breast cancer survivors

“…En conclusión, se debe ofrecer irradiación de la mama después de cirugía conservadora en todas las pacientes, aunque quizás se pueda considerar su omisión, tras discutirlo con la paciente y siempre que acepte un aumento pequeño pero significativo en el riesgo de eventos ipsilaterales, en aquellas mujeres con tumores de muy bajo riesgo que rechazan la radioterapia o que tienen comorbilidades graves. Finalmente, y aunque una revisión en profundidad de este tema está más allá del objetivo de este artículo, la aparición de recidiva local del CDIS tras mastectomía es un evento muy infrecuente, variando entre el 0 % y el 7,5 % según las diferentes series, pero su importancia radica en que la mayoría de ellos lo hacen en forma de carcinoma infiltrante (22,23). El grupo de Kelley y cols.…”