Skip to main content

Advertisement

SpringerLink
Log in

Current Therapeutic Approaches to DCIS

  • Published:
Journal of Mammary Gland Biology and Neoplasia Aims and scope Submit manuscript

Abstract

Treatment for ductal carcinoma in-situ (DCIS) has historically been extrapolated from studies of invasive breast cancer. Accepted local therapy approaches range from small local excisions, with or without radiation, to bilateral mastectomies. Systemic treatment with endocrine therapy is often recommended for hormone positive patients. With improvements in imaging, pathologic review, and treatment techniques in the modern era, combined with new information regarding tumor biology, the management of DCIS is rapidly evolving. A multidisciplinary approach to treatment is now more important than ever, with a shift towards de-escalating therapy to reduce treatment related toxicity. This review focuses on nuances of clinical management of DCIS in the modern era, highlighting key differences between DCIS as compared to invasive breast cancer. The American Cancer Society (ACS) currently recommends beginning screening with annual mammograms for women age 45, with the option to start at age 40. As treatment of DCIS has not been shown to impact survival, the USPSTF has more conservative screening recommendations of biennial mammograms from age 50–74. Unlike invasive breast cancer, DCIS is almost exclusively diagnosed by mammographic detection, and lymph node evaluation is not recommended. Pathologic review of biopsy specimens should follow the guidelines of the College of American Pathologists. Surgical management options include breast conservation, mastectomy, or possibly nipple sparing mastectomy, with upfront sentinel lymph node evaluation in the case of mastectomy. Radiation therapy is generally recommended as a component of breast conserving therapy for patients with DCIS, though in some low risk patients, there is trial data to suggest that adjuvant radiation may be omitted. Techniques for minimizing radiation toxicity should always be emphasized. Endocrine therapy is offered to women with hormone positive DCIS who have undergone lumpectomy for risk reduction, and has the benefit of decreasing incidence of events in both the ipsilateral and contralateral breast. More recent studies have explored use of targeted treatments such as trastuzumab in DCIS for HER2 overexpression. Future directions include tailoring therapy based on patient characteristics and tumor biology. With so many different options for treatment, it is also critical to engage in a discussion with the patient to arrive at a treatment decision that balances patient preferences for disease control versus treatment toxicity, financial toxicity, cosmesis, and quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

DCIS:

Ductal carcinoma in situ

References

  1. Society AC. Cancer Facts & Figures 2018. 2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf. Accessed 3/15/2018.

  2. Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599–614. https://doi.org/10.1001/jama.2015.12783.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75–89.

    Article  Google Scholar 

  4. Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):139–41. https://doi.org/10.1093/jncimonographs/lgq027.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 2015;1(7):888–96. https://doi.org/10.1001/jamaoncol.2015.2510.

    Article  PubMed  Google Scholar 

  6. Early Breast Cancer Trialists’ Collaborative G. Overview of the Randomized Trials of Radiotherapy in Ductal Carcinoma In Situ of the Breast. JNCI Monographs. 2010;2010(41):162–77. https://doi.org/10.1093/jncimonographs/lgq039.

    Article  Google Scholar 

  7. Benson JR, Jatoi I, Toi M. Treatment of low-risk ductal carcinoma in situ: is nothing better than something? Lancet Oncol. 2016;17(10):e442–e51. https://doi.org/10.1016/S1470-2045(16)30367-9.

    Article  PubMed  Google Scholar 

  8. Siu AL. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(4):279–96. https://doi.org/10.7326/m15-2886.

    Article  PubMed  Google Scholar 

  9. Desmond A, Kurian AW, Gabree M, Mills MA, Anderson MJ, Kobayashi Y, et al. Clinical Actionability of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer Risk Assessment. JAMA Oncol. 2015;1(7):943–51. https://doi.org/10.1001/jamaoncol.2015.2690.

    Article  PubMed  Google Scholar 

  10. Greenwood HI, Heller SL, Kim S, Sigmund EE, Shaylor SD, Moy L. Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics: A Review Publication of the Radiological Society of North America, Inc. 2013;33(6):1569–88. https://doi.org/10.1148/rg.336125055.

    Article  Google Scholar 

  11. Kuhl CK, Schrading S, Bieling HB, Wardelmann E, Leutner CC, Koenig R, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007;370(9586):485–92. https://doi.org/10.1016/S0140-6736(07)61232-X.

    Article  PubMed  Google Scholar 

  12. Pilewskie M, Olcese C, Eaton A, Patil S, Morris E, Morrow M, et al. Perioperative breast MRI is not associated with lower locoregional recurrence rates in DCIS patients treated with or without radiation. Ann Surg Oncol. 2014;21(5):1552–60. https://doi.org/10.1245/s10434-013-3424-5.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Protocol for the Examination of Specimens From Patients With Ductal Carcinoma In Situ (DCIS) of the Breast. 2018. http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-breast-dcis-18protocol-4100.pdf. Accessed 4/14/2018.

  14. Ajisaka H, Tsugawa K, Noguch M, Miwa M, Nonomura A. Histological subtypes of ductal carcinoma in situ of the breast. Breast Cancer. 2002;9(1):55–61.

    Article  Google Scholar 

  15. Lagios MD. Duct carcinoma in situ. Pathology and treatment. Surg Clin North Am. 1990;70(4):853–71.

    Article  CAS  Google Scholar 

  16. Hughes LL, Wang M, Page DL, Gray R, Solin LJ, Davidson NE, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol. 2009;27(32):5319–24. https://doi.org/10.1200/JCO.2009.21.8560.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Allred DC, Anderson SJ, Paik S, Wickerham DL, Nagtegaal ID, Swain SM, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol. 2012;30(12):1268–73. https://doi.org/10.1200/JCO.2010.34.0141.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lari SA, Kuerer HM. Biological Markers in DCIS and Risk of Breast Recurrence: A Systematic Review. J Cancer. 2011;2:232–61.

    Article  Google Scholar 

  19. Sanders ME, Schuyler PA, Simpson JF, Page DL, Dupont WD. Continued observation of the natural history of low-grade ductal carcinoma in situ reaffirms proclivity for local recurrence even after more than 30 years of follow-up. Mod Pathol. 2015;28(5):662–9. https://doi.org/10.1038/modpathol.2014.141.

    Article  PubMed  Google Scholar 

  20. Silverstein MJ, Barth A, Poller DN, Gierson ED, Colburn WJ, Waisman JR, et al. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer. 1995;31A(9):1425–7.

    Article  CAS  Google Scholar 

  21. Toth BA, Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg. 1991;87(6):1048–53.

    Article  CAS  Google Scholar 

  22. Cunnick GH, Mokbel K. Skin-sparing mastectomy. Am J Surg. 2004;188(1):78–84. https://doi.org/10.1016/j.amjsurg.2004.02.004.

    Article  PubMed  Google Scholar 

  23. Timbrell S, Al-Himdani S, Shaw O, Tan K, Morris J, Bundred N. Comparison of Local Recurrence After Simple and Skin-Sparing Mastectomy Performed in Patients with Ductal Carcinoma In Situ. Ann Surg Oncol. 2017;24(4):1071–6. https://doi.org/10.1245/s10434-016-5673-6.

    Article  PubMed  Google Scholar 

  24. Robertson SA, Rusby JE, Cutress RI. Determinants of optimal mastectomy skin flap thickness. Br J Surg. 2014;101(8):899–911. https://doi.org/10.1002/bjs.9470.

    Article  CAS  PubMed  Google Scholar 

  25. Wagner JL, Fearmonti R, Hunt KK, Hwang RF, Meric-Bernstam F, Kuerer HM, et al. Prospective evaluation of the nipple-areola complex sparing mastectomy for risk reduction and for early-stage breast cancer. Ann Surg Oncol. 2012;19(4):1137–44. https://doi.org/10.1245/s10434-011-2099-z.

    Article  PubMed  Google Scholar 

  26. Galimberti V, Vicini E, Corso G, Morigi C, Fontana S, Sacchini V, et al. Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications. Breast. 2017;34(Suppl 1):S82–4. https://doi.org/10.1016/j.breast.2017.06.034.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lago V, Maisto V, Gimenez-Climent J, Vila J, Vazquez C, Estevan R. Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study. Breast J. 2017. https://doi.org/10.1111/tbj.12947.

  28. Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260(1):119–28. https://doi.org/10.1148/radiol.11102368.

    Article  PubMed  Google Scholar 

  29. Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer--a multicenter validation study. N Engl J Med. 1998;339(14):941–6. https://doi.org/10.1056/NEJM199810013391401.

    Article  CAS  PubMed  Google Scholar 

  30. Rashtian A, Iganej S, Amy Liu IL, Natarajan S. Close or positive margins after mastectomy for DCIS: pattern of relapse and potential indications for radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72(4):1016–20. https://doi.org/10.1016/j.ijrobp.2008.06.1954.

    Article  PubMed  Google Scholar 

  31. Fitzsullivan E, Lari SA, Smith B, Caudle AS, Krishnamurthy S, Lucci A, et al. Incidence and consequence of close margins in patients with ductal carcinoma-in situ treated with mastectomy: is further therapy warranted? Ann Surg Oncol. 2013;20(13):4103–12. https://doi.org/10.1245/s10434-013-3194-0.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Childs SK, Chen YH, Duggan MM, Golshan M, Pochebit S, Punglia RS, et al. Impact of margin status on local recurrence after mastectomy for ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2013;85(4):948–52. https://doi.org/10.1016/j.ijrobp.2012.07.2377.

    Article  PubMed  Google Scholar 

  33. Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL. Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States? J Clin Oncol. 2006;24(4):626–34. https://doi.org/10.1200/JCO.2005.03.3365.

    Article  PubMed  Google Scholar 

  34. Rowland JH, Holland JC, Chaglassian T, Kinne D. Psychological response to breast reconstruction. Expectations for and impact on postmastectomy functioning. Psychosomatics. 1993;34(3):241–50. https://doi.org/10.1016/S0033-3182(93)71886-1.

    Article  CAS  PubMed  Google Scholar 

  35. Dikmans RE, Negenborn VL, Bouman MB, Winters HA, Twisk JW, Ruhe PQ, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 2017;18(2):251–8. https://doi.org/10.1016/S1470-2045(16)30668-4.

    Article  PubMed  Google Scholar 

  36. Pusic AL, Matros E, Fine N, Buchel E, Gordillo GM, Hamill JB, et al. Patient-Reported Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study. J Clin Oncol. 2017;35(22):2499–506. https://doi.org/10.1200/JCO.2016.69.9561.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Leyngold MM. Is Unipedicled Transverse Rectus Abdominis Myocutaneous Flap Obsolete Owing to Superiority of DIEP Flap? Ann Plast Surg. 2018. https://doi.org/10.1097/SAP.0000000000001319.

  38. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R. Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000;160(7):953–8.

    Article  CAS  Google Scholar 

  39. Smith BD, Jiang J, Shih YC, Giordano SH, Huo J, Jagsi R, et al. Cost and Complications of Local Therapies for Early-Stage Breast Cancer. J Natl Cancer Inst. 2017;109(1). https://doi.org/10.1093/jnci/djw178.

  40. NCCN Clinical Practice Guidelines in Oncology - Breast Cancer. In: NCCN Clinical ractice Guidelines in Oncology. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 4/14/2018.

  41. Lovrics PJ, Goldsmith CH, Hodgson N, McCready D, Gohla G, Boylan C, et al. A multicentered, randomized, controlled trial comparing radioguided seed localization to standard wire localization for nonpalpable, invasive and in situ breast carcinomas. Ann Surg Oncol. 2011;18(12):3407–14. https://doi.org/10.1245/s10434-011-1699-y.

    Article  PubMed  Google Scholar 

  42. Waddell BE, Stomper PC, DeFazio JL, Hurd TC, Edge SB. Postexcision mammography is indicated after resection of ductal carcinoma-in-situ of the breast. Ann Surg Oncol. 2000;7(9):665–8.

    Article  CAS  Google Scholar 

  43. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;32(14):1507–15. https://doi.org/10.1200/JCO.2013.53.3935.

    Article  PubMed  Google Scholar 

  44. Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ. J Clin Oncol. 2016;34(33):4040–6. https://doi.org/10.1200/JCO.2016.68.3573.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Dunne C, Burke JP, Morrow M, Kell MR. Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol. 2009;27(10):1615–20. https://doi.org/10.1200/JCO.2008.17.5182.

    Article  PubMed  Google Scholar 

  46. Kuerer HM, Smith BD, Chavez-MacGregor M, Albarracin C, Barcenas CH, Santiago L, et al. DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes. J Cancer. 2017;8(14):2653–62. https://doi.org/10.7150/jca.20871.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Baxter NN, Virnig BA, Durham SB, Tuttle TM. Trends in the treatment of ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2004;96(6):443–8.

    Article  Google Scholar 

  48. Veronesi P, Intra M, Vento AR, Naninato P, Caldarella P, Paganelli G, et al. Sentinel lymph node biopsy for localised ductal carcinoma in situ? Breast. 2005;14(6):520–2. https://doi.org/10.1016/j.breast.2005.08.007.

    Article  CAS  PubMed  Google Scholar 

  49. Cody HS 3rd, Van Zee KJ. Point: sentinel lymph node biopsy is indicated for patients with DCIS. J Natl Compr Cancer Netw. 2003;1(2):199–206.

    Article  Google Scholar 

  50. Cox CE, Nguyen K, Gray RJ, Salud C, Ku NN, Dupont E, et al. Importance of lymphatic mapping in ductal carcinoma in situ (DCIS): why map DCIS? Am Surg. 2001;67(6):513–9 discussion 9-21.

    CAS  PubMed  Google Scholar 

  51. Ansari B, Ogston SA, Purdie CA, Adamson DJ, Brown DC, Thompson AM. Meta-analysis of sentinel node biopsy in ductal carcinoma in situ of the breast. Br J Surg. 2008;95(5):547–54. https://doi.org/10.1002/bjs.6162.

    Article  CAS  PubMed  Google Scholar 

  52. Clough KB, van la Parra RFD, Thygesen HH, Levy E, Russ E, Halabi NM, et al. Long-term Results After Oncoplastic Surgery for Breast Cancer: A 10-year Follow-up. Ann Surg. 2017. https://doi.org/10.1097/SLA.0000000000002255.

  53. Fisher B, Costantino J, Redmond C, Fisher E, Margolese R, Dimitrov N, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993;328(22):1581–6. https://doi.org/10.1056/NEJM199306033282201.

    Article  CAS  PubMed  Google Scholar 

  54. Bijker N, Meijnen P, Peterse JL, Bogaerts J, Van Hoorebeeck I, Julien JP, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853--a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24(21):3381–7. https://doi.org/10.1200/JCO.2006.06.1366.

    Article  PubMed  Google Scholar 

  55. Holmberg L, Garmo H, Granstrand B, Ringberg A, Arnesson LG, Sandelin K, et al. Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast. J Clin Oncol. 2008;26(8):1247–52. https://doi.org/10.1200/JCO.2007.12.7969.

    Article  PubMed  Google Scholar 

  56. Houghton J, George WD, Cuzick J, Duggan C, Fentiman IS, Spittle M, et al. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet. 2003;362(9378):95–102.

    Article  Google Scholar 

  57. McCormick B, Winter K, Hudis C, Kuerer HM, Rakovitch E, Smith BL, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015;33(7):709–15. https://doi.org/10.1200/JCO.2014.57.9029.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. White J, Tai A, Arthur D, Buchholz TA, MacDonnald S, Marks L et al. Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions. 2009.

  59. Murthy KK, Sivakumar SS, Davis CA, Ravichandran R, El Ghamrawy K. Optimization of dose distribution with multi-leaf collimator using field-in-field technique for parallel opposing tangential beams of breast cancers. J Med Phys. 2008;33(2):60–3. https://doi.org/10.4103/0971-6203.41194.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20. https://doi.org/10.1056/NEJMoa0906260.

    Article  CAS  PubMed  Google Scholar 

  61. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086–94. https://doi.org/10.1016/S1470-2045(13)70386-3.

    Article  PubMed  Google Scholar 

  62. Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, Hahn C, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018. https://doi.org/10.1016/j.prro.2018.01.012.

  63. Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56. https://doi.org/10.1016/S1470-2045(14)71156-8.

    Article  PubMed  Google Scholar 

  64. Wong P, Lambert C, Agnihotram RV, David M, Duclos M, Freeman CR. Ductal carcinoma in situ--the influence of the radiotherapy boost on local control. Int J Radiat Oncol Biol Phys. 2012;82(2):e153–8. https://doi.org/10.1016/j.ijrobp.2011.03.045.

    Article  PubMed  Google Scholar 

  65. Eaton BR, Losken A, Okwan-Duodu D, Schuster DM, Switchenko JM, Mister D, et al. Local recurrence patterns in breast cancer patients treated with oncoplastic reduction mammaplasty and radiotherapy. Ann Surg Oncol. 2014;21(1):93–9. https://doi.org/10.1245/s10434-013-3235-8.

    Article  PubMed  Google Scholar 

  66. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987–98. https://doi.org/10.1056/NEJMoa1209825.

    Article  CAS  PubMed  Google Scholar 

  67. Bazan J, DiCostanzo D, Kuhn K, Majithia L, Quick A, Gupta N, et al. Likelihood of unacceptable normal tissue doses in breast cancer patients undergoing regional nodal irradiation in routine clinical practice. Pract Radiat Oncol. 2017;7(3):154–60. https://doi.org/10.1016/j.prro.2016.10.012.

    Article  PubMed  Google Scholar 

  68. Korreman SS, Pedersen AN, Nottrup TJ, Specht L, Nystrom H. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique. Radiother Oncol. 2005;76(3):311–8. https://doi.org/10.1016/j.radonc.2005.07.009.

    Article  PubMed  Google Scholar 

  69. Remouchamps VM, Letts N, Vicini FA, Sharpe MB, Kestin LL, Chen PY, et al. Initial clinical experience with moderate deep-inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy. Int J Radiat Oncol Biol Phys. 2003;56(3):704–15.

    Article  Google Scholar 

  70. Alderliesten T, Sonke JJ, Betgen A, Honnef J, van Vliet-Vroegindeweij C, Remeijer P. Accuracy evaluation of a 3-dimensional surface imaging system for guidance in deep-inspiration breath-hold radiation therapy. Int J Radiat Oncol Biol Phys. 2013;85(2):536–42. https://doi.org/10.1016/j.ijrobp.2012.04.004.

    Article  PubMed  Google Scholar 

  71. Verhoeven K, Sweldens C, Petillion S, Laenen A, Peeters S, Janssen H, et al. Breathing adapted radiation therapy in comparison with prone position to reduce the doses to the heart, left anterior descending coronary artery, and contralateral breast in whole breast radiation therapy. Pract Radiat Oncol. 2014;4(2):123–9. https://doi.org/10.1016/j.prro.2013.07.005.

    Article  PubMed  Google Scholar 

  72. Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74(4):987–1001. https://doi.org/10.1016/j.ijrobp.2009.02.031.

    Article  PubMed  Google Scholar 

  73. Park SS, Grills IS, Chen PY, Kestin LL, Ghilezan MI, Wallace M, et al. Accelerated partial breast irradiation for pure ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2011;81(2):403–8. https://doi.org/10.1016/j.ijrobp.2010.05.030.

    Article  PubMed  Google Scholar 

  74. Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, et al. Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Pract Radiat Oncol. 2017;7(2):73–9. https://doi.org/10.1016/j.prro.2016.09.007.

    Article  PubMed  Google Scholar 

  75. Holliday EB, Kirsner SM, Thames HD, Mason BE, Nelson CL, Bloom ES. Lower mean heart dose with deep inspiration breath hold-whole breast irradiation compared with brachytherapy-based accelerated partial breast irradiation for women with left-sided tumors. Pract Radiat Oncol. 2017;7(2):80–5. https://doi.org/10.1016/j.prro.2016.07.007.

    Article  PubMed  Google Scholar 

  76. Sagara Y, Freedman RA, Vaz-Luis I, Mallory MA, Wong SM, Aydogan F, et al. Patient Prognostic Score and Associations With Survival Improvement Offered by Radiotherapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study. J Clin Oncol. 2016;34(11):1190–6. https://doi.org/10.1200/JCO.2015.65.1869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Wong JS, Kaelin CM, Troyan SL, Gadd MA, Gelman R, Lester SC, et al. Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol. 2006;24(7):1031–6. https://doi.org/10.1200/JCO.2005.02.9975.

    Article  PubMed  Google Scholar 

  78. Solin LJ, Gray R, Hughes LL, Wood WC, Lowen MA, Badve SS, et al. Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study. J Clin Oncol. 2015;33(33):3938–44. https://doi.org/10.1200/JCO.2015.60.8588.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Smith BD, Haffty BG, Buchholz TA, Smith GL, Galusha DH, Bekelman JE, et al. Effectiveness of Radiation Therapy in Older Women With Ductal Carcinoma In Situ. JNCI: Journal of the National Cancer Institute. 2006;98(18):1302–10. https://doi.org/10.1093/jnci/djj359.

    Article  PubMed  Google Scholar 

  80. Halasz LM, Sreedhara M, Chen YH, Bellon JR, Punglia RS, Wong JS, et al. Improved outcomes of breast-conserving therapy for patients with ductal carcinoma in situ. Int J Radiat Oncol Biol Phys. 2012;82(4):e581–6. https://doi.org/10.1016/j.ijrobp.2011.08.015.

    Article  PubMed  Google Scholar 

  81. Silverstein MJ, Buchanan C. Ductal carcinoma in situ: USC/Van Nuys Prognostic Index and the impact of margin status. Breast. 2003;12(6):457–71.

    Article  Google Scholar 

  82. Solin LJ, Gray R, Baehner FL, Butler SM, Hughes LL, Yoshizawa C, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2013;105(10):701–10. https://doi.org/10.1093/jnci/djt067.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Rakovitch E, Nofech-Mozes S, Hanna W, Baehner FL, Saskin R, Butler SM, et al. A population-based validation study of the DCIS Score predicting recurrence risk in individuals treated by breast-conserving surgery alone. Breast Cancer Res Treat. 2015;152(2):389–98. https://doi.org/10.1007/s10549-015-3464-6.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Raldow AC, Sher D, Chen AB, Recht A, Punglia RS. Cost Effectiveness of the Oncotype DX DCIS Score for Guiding Treatment of Patients With Ductal Carcinoma In Situ. J Clin Oncol. 2016;34(33):3963–8. https://doi.org/10.1200/JCO.2016.67.8532.

    Article  PubMed  Google Scholar 

  85. Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER, Mamounas E, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 1999;353(9169):1993–2000. https://doi.org/10.1016/S0140-6736(99)05036-9.

    Article  CAS  PubMed  Google Scholar 

  86. Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478–88. https://doi.org/10.1093/jnci/djr027.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow LA, et al. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387(10021):849–56. https://doi.org/10.1016/S0140-6736(15)01168-X.

    Article  CAS  PubMed  Google Scholar 

  88. Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, et al. Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387(10021):857–65. https://doi.org/10.1016/S0140-6736(15)01169-1.

    Article  CAS  PubMed  Google Scholar 

  89. Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol. 2011;12(1):21–9. https://doi.org/10.1016/S1470-2045(10)70266-7.

    Article  CAS  PubMed  Google Scholar 

  90. Stackievicz R, Paran H, Bernheim J, Shapira M, Weisenberg N, Kaufman T, et al. Prognostic significance of HER-2/neu expression in patients with ductal carcinoma in situ. Isr Med Assoc J. 2010;12(5):290–5.

    PubMed  Google Scholar 

  91. Siziopikou KP, Anderson SJ, Cobleigh MA, Julian TB, Arthur DW, Zheng P, et al. Preliminary results of centralized HER2 testing in ductal carcinoma in situ (DCIS): NSABP B-43. Breast Cancer Res Treat. 2013;142(2):415–21. https://doi.org/10.1007/s10549-013-2755-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Erbas B, Provenzano E, Armes J, Gertig D. The natural history of ductal carcinoma in situ of the breast: a review. Breast Cancer Res Treat. 2006;97(2):135–44. https://doi.org/10.1007/s10549-005-9101-z.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, The Kansas University Medical Center, 3901 Rainbow Blvd., Mailstop 4033, Kansas City, KS, 66160, USA

    Kaleigh Doke, Shirley Butler & Melissa P. Mitchell

Authors
  1. Kaleigh Doke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shirley Butler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melissa P. Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melissa P. Mitchell.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doke, K., Butler, S. & Mitchell, M.P. Current Therapeutic Approaches to DCIS. J Mammary Gland Biol Neoplasia 23, 279–291 (2018). https://doi.org/10.1007/s10911-018-9415-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10911-018-9415-1

Keywords

Search

Navigation