Is Wide Excision Alone an Appropriate Therapy for DCIS?

Abstract

With the widespread use of screening mammography, the number of ductal carcinoma in situ (DCIS) cases has increased dramatically. Current treatment includes wide local excision (WLE) and adjuvant radiation therapy (RT). The benefit of RT in decreasing local recurrence was established based on the results of four randomized trials and a subsequent meta-analysis. However, RT has a number of side effects and no demonstrated survival benefit in women with in situ breast cancer. This review explores the current literature on the management of DCIS with WLE alone. Although there is insufficient evidence to identify truly low-risk DCIS based on histopathological and immunohistochemical factors, emerging data appear promising in understanding the biological behavior of DCIS. In particular, the Oncotype DX DCIS Score, a multigene assay, predicts local recurrence in women treated with WLE. Risk stratification of DCIS to guide treatment decisions remains elusive, but one of great importance in tailoring therapies to the biology of this heterogeneous disease.