Management of screen detected ductal carcinoma in situ of the female breast

Carpenter, R; Boulter, P. S.; Cooke, Timothy G.; Gibbs, N. M.

doi:10.1002/bjs.1800760612

Cited by 68 publications

(17 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…BCS without postoperative RT has been widely used for the treatment of DCIS (Table 1) [10][11][12][13][14][15][16][17][18][19]. The largest series of 256 patients was reported by Schwartz et al [18].…”

Section: Non-randomised Studies Using Conservative Surgery Alonementioning

confidence: 98%

The Role of Radiotherapy in the Conservative Treatment of Ductal Carcinoma in Situ of the Breast

Polgár

Kahán

Orosz

et al. 2008

Pathol. Oncol. Res.

View full text Add to dashboard Cite

Breast-conserving surgery (BCS) followed by radiotherapy (RT) has become the standard of care for the treatment of early-stage (St. I-II) invasive breast carcinoma. However, controversy exists regarding the value of RT in the conservative treatment of ductal carcinoma in situ (DCIS). In this article we review the role of RT in the management of DCIS. Retrospective and prospective trials and meta-analyses published between 1975 and 2007 in the MEDLINE database, and recent issues of relevant journals/handbooks relating to DCIS, BCS and RT were searched for. In retrospective series (10,194 patients) the 10-year rate of local recurrence (LR) with and without RT was reported in the range of 9-28% and 22-54%, respectively. In four large randomised controlled trials (NSABP-B-17, EORTC-10853, UKCCCR, SweDCIS; 4,568 patients) 50 Gy whole-breast RT significantly decreased the 5-year LR rate from 16-22% (annual LR rate: 2.6-5.0%) to 7-10% (annual LR rate: 1.3-1.9%). In a recent meta-analysis of randomised trials the addition of RT to BCS resulted in a 60% risk reduction of both invasive and in situ recurrences. In a multicentre retrospective study, an additional dose of 10 Gy to the tumour bed yielded a further 55% risk reduction compared to RT without boost. To date, no subgroups have been reliably identified that do not benefit from RT after BCS. In the NSABP-B-24 trial, the addition of tamoxifen (TAM) to RT reduced ipsilateral (11.1% vs. 7.7%) and contralateral (4.9% vs. 2.3%) breast events significantly. In contrast, in the UKCCCR study, TAM produced no significant reduction in all breast events. Based on available evidence obtained from retrospective and prospective trials, all patients with DCIS have potential benefit from RT after BCS. Further prospective studies are warranted to identify subgroups of low-risk patients with DCIS for whom RT can be safely omitted. Until long-term results of ongoing studies on outcomes of patients treated with BCS alone (with or without TAM or aromatase inhibitors) are available, RT should be routinely recommended after BCS for all patients except those with contraindication.

show abstract

Section: Non-randomised Studies Using Conservative Surgery Alonementioning

confidence: 98%

The Role of Radiotherapy in the Conservative Treatment of Ductal Carcinoma in Situ of the Breast

Polgár

Kahán

Orosz

et al. 2008

Pathol. Oncol. Res.

View full text Add to dashboard Cite

show abstract

“…Although certainly effective, there is a small but significant recurrence rate ranging between 0-10% [4,15,30,34,36,44]. The question is not the propriety of mastectomy but whether breast-sparing surgery, as has been clearly demonstrated for invasive breast cancer, provides similar disease-free and overall survival.…”

Section: Ductal Carcinoma In-situmentioning

confidence: 98%

“…Several recent small prospective series have addressed the value of breast-preserving operations in patients with DCIS. Three representative series [31,44,45] employing breast-preserving operations without radiation therapy are listed in Table Table 2 3. In all three series, patients with DCIS were identified from a mammographically screened population and an effort was made to achieve margins histologically free of tumor.…”

Section: Ductal Carcinoma In-situmentioning

confidence: 99%

Non-invasive breast carcinoma

Posner

Wolmark

1992

Breast Cancer Res Tr

View full text Add to dashboard Cite

Non-invasive breast cancer is comprised of two distinct entities: lobular carcinoma in-situ (LCIS) and ductal carcinoma in-situ (DCIS). The natural history of each clinical entity is described and a biologic interpretation of the available data is offered. Lobular carcinoma in-situ is considered only a risk marker rather than a precursor for the subsequent development of invasive cancer, so that once the diagnosis is established, further operative intervention is unnecessary and serial follow-up alone is recommended. The treatment of ductal carcinoma in-situ must take into account that breast-preserving therapy is now considered optimal treatment of invasive cancer of the breast, the disease we are trying to prevent. The pitfalls of recommending treatment based on retrospective data is emphasized and the need to support clinical trials designed to determine the optimal therapeutic management of intraductal carcinoma is affirmed.

show abstract

“…These lesions have a high proliferative rate, and they often show aneuploidy, overexpression of the HER2/NEU (c-erbB-2) oncogene, accumulation of p53 tumor suppressor gene protein product, and angiogenesis in the surrounding stroma. [1][2][3][4][5] Using standard two-view mammography, there is a high correlation between the histologic extent of the lesion and the extent of the calcifications on mammogram. 6 Some investigators group the remaining subtypes of DCIS together as "non-comedo" lesions, based on the perception that these other types are often composed of cytologically bland cells with low-grade nuclei and a low proliferative rate.…”

Section: Pathologymentioning

confidence: 99%