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The Oncologist, Vol. 12, No. 11, 1276-1287, November 2007; doi:10.1634/theoncologist.12-11-1276
© 2007 AlphaMed Press

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 Current Treatment and Clinical Trial Developments for Ductal Carcinoma In S...
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Breast Cancer

Current Treatment and Clinical Trial Developments for Ductal Carcinoma In Situ of the Breast

Judy C. Bougheya, Ricardo J. Gonzalezb, Everett Bonnerc, Henry M. Kuererb

aDepartment of Surgery, Mayo Clinic, Rochester, Minnesota, USA; bDepartment of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA; cDepartment of Surgery, Memorial Health University Medical Center, Savannah, Georgia, USA

Key Words. Ductal carcinoma in situ • Radiation • Tamoxifen • Trastuzumab

Correspondence: Henry M. Kuerer, M.D., Ph.D., Department of Surgical Oncology, Box 444, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. Telephone: 713-745-5043; Fax: 713-792-4689; e-mail: hkuerer{at}mdanderson.org

Disclosure: No potential conflicts of interest were reported by the authors, planners, reviewers, or staff managers of this article.

Ductal carcinoma in situ (DCIS) is the fastest growing subtype of breast cancer, mainly because of the aging of our populations and improvements in diagnostic mammography and core biopsy. DCIS represents a proliferation of malignant-appearing cells that have not invaded beyond the ductal basement membrane and is a precursor for the development of invasive breast cancer (IBC). Approximately 40% of patients with DCIS treated with biopsy alone, without complete excision or further therapy, develop IBC. Most DCIS itself is harmless if it is detected and excised before it can progress to IBC, and the current approach to DCIS treatment is aimed at just that goal. Typically, it consists of multimodal treatment including segmental mastectomy followed by radiation therapy to the whole breast and then hormonal therapy or total mastectomy followed by hormonal therapy.

This review discusses the state-of-the-art in DCIS detection and treatment and highlights promising new strategies in the care of DCIS patients. The data regarding the effectiveness of breast-conserving surgery versus total mastectomy, the possible avoidance of radiation therapy in some subgroups of patients, and the role of hormonal agents are reviewed. Neoadjuvant therapy and the use of trastuzumab for DCIS are currently under investigation and may be future treatment options for DCIS.






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