Ductal carcinoma in situ: a challenging disease
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REVIEW
Ductal carcinoma in situ: a challenging disease Sevilay Altintas • Manon T. Huizing • Eric Van Marck • Jan B. Vermorken • Wiebren A. Tjalma
Received: 19 February 2010 / Accepted: 18 May 2010 / Published online: 15 June 2010 Springer-Verlag 2010
Abstract Ductal carcinoma in situ (DCIS) represents a heterogenous group of lesions with variable malignant potential. Although it is clearly pre-invasive, not all lesions progress to an invasive malignant disease. The significant increase in the frequency of diagnosis is the result of both widespread use of screening mammography and better recognition among pathologists. Treatment is controversial, but for several decades total mastectomy has been considered as the appropriate treatment. The tendency to be less aggressive in terms of surgery has followed the pattern of events observed in the treatment of invasive breast carcinomas. More recently, it has become clear that breastconserving procedures could be applied and selected on the basis of diagnostics and risk factors. When all patients with DCIS are considered, the overall mortality is extremely low, only about 1–2%. On the other hand, breast-conserving surgery is only curative in 75–85%; 50% of the local recurrences have proven to be invasive with a mortality rate of 12–15%. There is no place for axillary node dissection, adjuvant hormonal treatment or chemotherapy in the treatment. Important factors in predicting local recurrence are age, family history, nuclear grade, comedo-type necrosis, tumor size and margin width. With the addition of radiation therapy to excisional surgery, there is a 50% reduction in the overall local recurrence rate. The Van Nuys Prognostic Index (VNPI), recently updated, is a tool that quantifies measurable prognostic factors that can be used in the decision-making process of treatment. Recent data from large cohort studies and randomized trials have emerged to guide treatment. DCIS is now understood to have diverse S. Altintas (&) M. T. Huizing E. Van Marck J. B. Vermorken W. A. Tjalma Antwerp University Hospital Edegem, Antwerp, Belgium e-mail: [email protected]
malignant potential and it is unlikely that there will be a single treatment for this wide range of lesions. Advances in molecular biology and gene expression profiling of human breast tumors have been providing important insights into the relationship between DCIS and invasive breast cancer. Keywords Ductal carcinoma Mastectomy Invasive breast cancer
Definition The term ‘‘in situ carcinoma of the breast’’ or ductal carcinoma in situ (DCIS) was first used in 1932 [1]. It is the most common type of noninvasive breast cancer in women and refers to the development of cancer cells within the milk ducts of the breast. In situ means ‘‘in place’’ and refers to the fact that the cancer has not moved out of the duct and into any surrounding tissue [2].
Epidemiology Before the 1980s, when most cases of breast carcinoma were detected by physical examination (palpable breast masses, bloody nipple discharge or Pag
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