Abstract: Ductal carcinoma in-situ DCIS is a heterogeneous entity in breast neoplasm with unpredictable biological behavior. This poses challenge in the management of DCIS. Various trials on DCIS have shown good outcome with integral treatment of adequate surgery, radiotherapy and hormonal therapy. Identification of subgroup of DCIS for radiotherapy and hormonal therapy could improve recurrence rate, contralateral tumours incidence and perhaps overall survival. Various risk score calculations could help to direct radiotherapy and hormonal treatment verses surgery alone and to avoid over treatment. Oncotype DX assay could be a new way of risk calculation to direct types of DCIS treatment. The recent increased use of MRI could increase the detection of DCIS and a more accurate extent of disease estimation. This article is a summary of major literatures and major trials result for DCIS .
KeywordsEarly Breast CancerDCISBreast Cancer Diagnosis and Treatment
N. Patani, Y. Khaled, S. Al Reefy and K. Mokbel, “Ductal Carcinoma in-Situ: An Update for Clinical Practice,” Surgical Oncology, Vol. 20, No. 1, 2011, pp. E23-E31. http://dx.doi.org/10.1016/j.suronc. 2010.08.007
H. I. Greenwood, S. L.Heller, S. Kim, E. E. Sigmund, S. D. Shaylor and L. Moy, “Ductal Carcinoma in Situ of the Breasts: Review of MR Imaging Features,” Radiographics, Vol. 33, No. 6, 2013, pp. 1569-1588. http://dx.doi.org/10.1148/rg.336125055
K. Kerlikowske, A Molinaro, I. Cha, B. M. Ljung, V. L. Ernster, K. Stewart, K. Chew, D. H. Moore 2nd and F. Waldman, “Characteristics Associated with Recurrence among Women with Ductal Carcinoma in-Situ Treated by Lumpectomy,” Journal of the National Cancer Institute, Vol. 95, No. 22, 2003, pp. 1692-1702. http://dx.doi.org/10.1093/jnci/djg097
N. Bijker, J. L. Peterse, L. Duchateau, J. P. Julien, I. S. Fentiman, C. Duval, S. Di Palma, J. Simony-Lafontaine, I. de Mascarel and M. J. van de Vijver, “Risk Factors for Recurrence and Metastasis after Breast Conserving Therapy for Ductal Carcinoma in-Situ: Analysis of European Organisation for Research and Treatment of Cancer Trial 10853,” Journal of Clinical Oncology, Vol. 19, No. 8, 2001, pp. 2263-2271.
B. A. Virnig, T. Tuttle, T. Shamliyan and R. Kane, “Ductal Carcinoma in Situ of the Breast: A Systematic Review of Incidence, Treatment, and Outcomes,” Journal of the National Cancer Institute, Vol. 102, No. 3, 2010, pp. 170-178. http://dx.doi.org/10.1093/jnci/djp482
M. G. Marmot, D. G. Altman, D. A. Cameron, J. A. Dwer, S. G. Thompson and M. Wilcox, “Independent UK Panel on Breast Cancer Screening. The Benefits and Harms of Breast Cancer Screening: An Independent Review,” Lancet, Vol. 380, No. 9855, 2012, pp. 1778-1786. http://dx.doi.org/10.1016/ S0140-6736(12)61611-0
S. Wang, T. Shamliyan, B. Virnig and R. Kane, “Tumorcharacteristicsas Predictors of Local Recurrence after Treatment of Ductal Carcinoma in Situ: A Meta-Analysis,” Breast Cancer Research and Treatment, Vol. 127, No. 1, 2011, pp. 1-14. http://dx.doi.org/10.1007/s10549-011-1387-4
M. Clark, R. Collins, G. Godwin, R. Gray, R. Peto, et al. (Early Breast Cancer Trialists’ Collaborative Group), “Effects of Radiotherapy and Surgery in Early Breast Cancer—An Overview of the Randomized Trials,” The New England Journal of Medicine, Vol. 333, No. 22, 1995, pp. 1444-1455. http://dx.doi.org/10.1056/NEJM199511303332202
M. Clarke, R. Collins, S. Darby, C. Davies, P. Elphinstone, E. Evans, J. Godwin, R. Gray, C. Hicks, S. James, E. MacKinnon, P. McGale, T. McHugh, R. Peto, C. Taylor, Y. Wang and Early Breast Cancer Trialists’ Collaborative Group, “Effects of Radiotherapy and of Differences in the Extent of Surgery for Early Breast Cancer on Local Recurrence and 15-Year Survival: An Overview of the Randomised Trials,” Lancet, Vol. 366, No. 9503, 2005, pp. 2087-2106. http://dx.doi.org/10.1016/S0140-6736(05) 67887-7
S. Darby, P. McGale, C. Correa, C. Taylor, R. Arriagada, M. Clarke, D. Cutter, C. Davies, M. Ewertz, J. Godwin, R. Gray, L. Pierce, T. Whelan, Y. Wang, R. Peto and Early Breast Cancer Trialists’ Collaborative Group, “Effect of Radiotherapy after Breast-Conserving Surgery on 10-Year Recurrence and 15-Year Breast Cancer Death: Meta-Analysis of Individual Patient Data for 10,801 Women in 17 Randomised Trials,” Lancet, Vol. 378, No. 9804, 2011, pp. 1707-1716. http://dx.doi.org/10.1016/ S0140-6736(11)61629-2
I. L. Wapnir, J. J. Dignam, B. Fisher, E. P. Mamounas, S. J. Anderson, T. B. Julian, S. R. Land, R. G. Margolese, S. M. Swain, J. P. Constantino and N. Wolmark, “Long-Term Outcomes of Invasive Ipsilateral Breast Tumor Recurrences after Lumpectomy in NSABP B-17 and B-24 Randomized Clinical Trials for DCIS,” Journal of the National Cancer Institute, Vol. 103, No. 6, 2011, pp. 478-488. http://dx.doi.org/10.1093/jnci/djr027
M. Donker, S. Litière, G. Werutsky, J. P. Julian, I. S. Fentiman, R. Agresti, P. Rouanet, C. T. de Lara, H. Bartelink, N. Duez, E. J. Rutgers and N. Bijker, “Breast-Conserving Treatment with or without Radiotherapy in Ductal Carcinoma in Situ: 15-Year Recurrence Rates and Outcome after a Recurrence. From the EORTC 10853 Randomized Phase III Trial,” Journal of Clinical Oncology, Vol. 31, No. 32, 2013, pp. 4045-4059. http://dx.doi.org/10.1200/JCO.2013.49.5077
J. Cuzick, I. Sestak, S. Pinder, I. Ellis, S. Forsyth, N. J. Bundred, J. F. Forbes, H. Bishop, I. S. Fentiman and W. D. George, “Effect of Tamoxifen and Radiotherapy in Women with Locally Excised Ductal Carcinoma in Situ: Long-Term Results from the UK/ANZ DCIS Trial,” The Lancet Oncology, Vol. 12, No. 1, 2011, pp. 21-29. http://dx.doi.org/10.1016/S1470-2045(10)70266-7
F. Petrelli and S. Barni, “Tamoxifen Added to Radiotherapy and Surgery for the Treatment of Ductal Carcinoma in Situ of the Breast: A Meta-Analysis of 2 Randomized Trials,” Radiotherapy and Oncology, Vol. 100, No. 2, 2011, pp. 195-199. http://dx.doi.org/10.1016/j.radonc.2011.02.005
B. L. Sprague, V. McLaughlin, J. M. Hampton, P. A. Newcomb and A. Trentham-Dietz, “Disease-Free Survival by Treatment after a DCIS Diagnosis in a Population-Based Cohort Study,” Breast Cancer Research and Treatment, Vol. 141, No. 1, 2013, pp. 145-154. http://dx.doi.org/10.1007/s10549-013-2670-3
S. E. Pinder, C. Duggan, I. O. Ellis, J. Cuzick, J. F. Forbes, H. Bishop, I. S. Fentiman, W. D. George and UK Coordinating Committee on Cancer Research (UKCCCR) Ductal Carcinoma in Situ (DCIS) Working Party, “A New Pathological System for Grading DCIS with Improved Prediction of Local Recurrence: Results from the UKCCCR/ANZ DCIS Trial,” British Journal of Cancer, Vol. 103, No. 1, 2010, pp. 94-100. http://dx.doi.org/10.1038/sj.bjc.6605718
M. J. Silverstein, “The University of Southern California/Van Nuys Prognostic Index for Ductal Carcinoma in Situ of the Breast,” The American Journal of Surgery, Vol. 186, No. 4, 2003, pp. 337-343. http://dx.doi.org/10.1016/S0002-9610(03)00265-4
L. J. Solin, R. Gray, F. L. Baehner, S. M. Butler, L. L. Hughes, C. Yoshizawa, D. B. Cherbavaz, S. Shak, D. L. Page, G. W. Sledge Jr., N. E. Davidson, J. N. Ingle, E. A. Perez, W. C. Wood, J. A. Sparano and S. Badve, “A Multigene Expression Assay to Predict Local Recurrence Risk for Ductal Carcinoma in Situ of the Breast,” Journal of the National Cancer Institute, Vol. 105, No. 10, 2013, pp. 701-710. http://dx.doi.org/10.1093/jnci/djt067
S. B. Motwani, S. Goyal, M. S. Moran, A. Chhabra and B. G. Haffty, “Ductal Carcinoma in Situ Treated with Breast-Conserving Surgery and Radiotherapy: A Comparison with ECOG Study 5194,” Cancer, Vol. 117, No. 6, 2011, pp. 1156-1162. http://dx.doi.org/10.1002/cncr.25623