Treatment of Ductal Carcinoma In Situ: Considerations for Tailoring Therapy in the Contemporary Era

AbstractPurpose of ReviewStandard options for the treatment of ductal carcinoma in situ (DCIS) include breast-conserving surgery (BCS) alone; BCS with radiotherapy or endocrine therapy, or both; and mastectomy. Survival is excellent with all options, but rates of local recurrence (LR) vary, as do quality-of-life measures. Here, we discuss treatment outcomes, risk factors for LR, and tools for risk estimation.Recent FindingsAfter BCS, radiotherapy reduces the risk of LR by half, and endocrine therapy reduces the risk by a third. Young age, inadequate margins, and greater volume of disease are associated with higher risk of LR after BCS, while young age, high grade, and microinvasion are associated with higher risk of locoregional recurrence after mastectomy. Clinical tools, including the Memorial Sloan Kettering Cancer Center (MSKCC) DCIS nomogram, provide LR risk estimates after BCS that appear more accurate than current genomic assays. The safety of active surveillance for seemingly low-risk patients remains uncertain.SummaryEstimation of LR risk, utilizing a multitude of clinicopathologic and treatment factors, can help a woman balance that risk with her values and priorities, and allow her to choose the optimal treatment option for her.
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research

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CONCLUSIONS: Intra-lesion genetic heterogeneity is a common feature in DCIS synchronously diagnosed with IDC-NST. DCIS is a non-obligate precursor of IDC-NST, whose mechanisms of progression to invasive breast cancer are diverse and vary from case to case. PMID: 32220886 [PubMed - as supplied by publisher]
Source: Clinical Cancer Research - Category: Cancer & Oncology Authors: Tags: Clin Cancer Res Source Type: research
n Jing Wang To characterize molecular changes accompanying the stepwise progression to breast cancer and to identify functional target pathways, we performed miRNA and RNA sequencing using MCF10A cell lines based model system that replicates the multi-step progression involving normal, preneoplastic, ductal carcinoma in situ, and invasive carcinoma cells, where the carcinoma most resemble the basal-like subgroup of human breast cancers. These analyses suggest that 70% of miRNA alterations occurred during the initial progression from normal to a preneoplastic stage. Most of these early changes reflected a global upreg...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
Authors: Mori N, Mugikura S, Miyashita M, Mori Y, Maekawa Y, Nagasaka T, Takase K Abstract PURPOSE: To compare the image quality between turbo spin-echo (TSE)-diffusion weighted imaging (DWI) and single-shot echo-planar imaging (EPI)-DWI, and to verify the diagnostic performance of the apparent diffusion coefficient (ADC) parameters of the two techniques by using histogram analysis in terms of differentiation between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) lesions. METHODS: Ninety-four women with 94 lesions diagnosed as breast cancer by surgery underwent IRB-approved preoperative mag...
Source: Magnetic Resonance in Medical Sciences - Category: Radiology Tags: Magn Reson Med Sci Source Type: research
CONCLUSIONS: MBC has increasing incidence. PR-negative status was associated with better overall survival and disease-free interval. Indications to radiotherapy and hormonal therapy need standardization and will benefit from prospective randomized control trials. PMID: 32147980 [PubMed - in process]
Source: The Israel Medical Association Journal - Category: General Medicine Tags: Isr Med Assoc J Source Type: research
In conclusion, LOY is an early event in male breast carcinogenesis, which generally starts at the DCIS stage and is associated with ER and PR negative tumors.
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
We report the development of a robotic nipple-sparing mastectomy with immediate reconstruction through a single incision using the updated single-port surgical robot system for a patient with ductal carcinoma in situ (DCIS). Breast reconstruction was performed using implants. Postoperative pathological examination revealed DCIS in both breasts. There were no major immediate complications, except for a minor skin burn on the right breast. Overall, the initial operation using the updated platform was safely performed. PMID: 32140275 [PubMed]
Source: Journal of Breast Cancer - Category: Cancer & Oncology Tags: J Breast Cancer Source Type: research
Contributors : Hsin-Tien Tsai ; Ching-Shui Huang ; Chao-Chiang Tu ; Chih-Yi Liu ; Chi-Jung Huang ; Yuan-Soon Ho ; Shih-Hsin Tu ; Ling-Ming Tseng ; Chi-Cheng HuangSeries Type : Expression profiling by arrayOrganism : Homo sapiensMicrocalcification is one of the most common radiological and pathological features of breast ductal carcinoma in situ (DCIS), and to a lesser extent, invasive ductal carcinoma. We evaluated transcriptional profiles associated with ectopic mammary mineralization.We evaluated the transcriptional profiles associated with breast cancer microcalcification for Taiwanese breast cancer and a gene expressio...
Source: GEO: Gene Expression Omnibus - Category: Genetics & Stem Cells Tags: Expression profiling by array Homo sapiens Source Type: research
PMID: 32125939 [PubMed - as supplied by publisher]
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: J Clin Oncol Source Type: research
Abstract PURPOSE: Primary endocrine therapy for ductal carcinoma in situ (DCIS) as a potential alternative to surgery has been understudied. This trial explored the feasibility of a short-term course of letrozole and sought to determine whether treatment results in measurable radiographic and biologic changes in estrogen receptor (ER)-positive DCIS. PATIENTS AND METHODS: A phase II single-arm multicenter cooperative-group trial was conducted in postmenopausal patients diagnosed with ER-positive DCIS without invasion. Patients were treated with letrozole 2.5 mg per day for 6 months before surgery. Breast magne...
Source: Clinical Breast Cancer - Category: Cancer & Oncology Authors: Tags: J Clin Oncol Source Type: research
Conclusion: Our results demonstrate persistent use of advanced imaging tests for routine metastatic screening among patients with stage 0–II breast cancer despite the release of the ASCO Choosing Wisely recommendations and the update of our provincial breast cancer staging guideline. Investigation of strategies for guideline translation to improve upon value-based care of patients with early breast cancer is warranted. PMID: 32109016 [PubMed - as supplied by publisher]
Source: Canadian Journal of Surgery - Category: Surgery Authors: Tags: Can J Surg Source Type: research
More News: Breast Cancer | Breast Carcinoma | Breast Conservation Surgery | Cancer | Cancer & Oncology | Carcinoma | Carcinoma in Situ | DCIS (Ductal Carcinoma in Situ) | Ductal Carcinoma | Endocrine Therapy | Mastectomy