NEW STRATEGIES IN THE TREATMENT OF IN SITU DUCTAL BREAST CARCINOMA

Purpose: The increasing incidence and biological heterogenecity of ductal carcinoma in situ of the breast have made the management of this entity challenging and controversial. This paper reviews data on the natural history of the disease and results obtained with various management approaches. Material and Methods: Computerized MEDLINE search of articles related to ductal carcinoma in situ published since 1966. Randomized trials were given higher value. No formal statistical calculations were made. Results: The incidence of ductal carcinoma in situ is increasing and a greater proportion of diagnoses are being made in asymptomatic patients. A large randomized trial comparing lumpectomy with lumpectomy plus radiotherapy showed lumpectomy plus radiotherapy to be effective for management of this disease. The presence of comedo necrosis and surgical margins status are frequently used as predictors of subsequent recurrence. The risk for in-breast recurrence at 5 years after lumpectomy and radiotherapy is approximately 8%. With more refined molecular analysis the relation of ductal carcinoma in situ to invasive breast cancer will be better defined. Conclusions: Treatment strategies for ductal carcinoma in situ have evolved and lumpectoly followed by radiotherapy is an appropriate alternative for most patients.