title: Local failure and prognostic factors in ductal carcinoma in situ: concentration on recent publications.
abstract: OBJECTIVE
  Traditional therapy for ductal carcinoma in situ has been mastectomy or conservative surgery plus radiation, but interest in more expeditious therapies such as conservative surgery alone is growing. A first step in considering changes in an already successful treatment is to evaluate tumor and patient factors that may predict outcome. Identifying and understanding these prognostic factors will aid researchers in designing new treatment paradigms. The purpose of this review is to assess the value of commonly accepted potential prognostic factors in patients with ductal carcinoma in situ.
  
  
  RESULTS
  During this past year several retrospective studies have evaluated putative prognostic factors in ductal carcinoma in situ. We will compare these later publications with results from prospective randomized trials and one meta-analysis.
  
  
  CONCLUSIONS
  There does not appear to be unanimous agreement on the prognostic factors associated with increased risk of local failure in patients treated with conservative surgery and radiation for ductal carcinoma in situ. In our chosen papers, however, comedonecrosis and positive margins are most likely prognostic factors for increased local failure.
authors.affiliation: Division of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland 21231-2410, USA. zellari@jhmi.edu
authors.forename: Richard
authors.initials: R
authors.lastname: Zellars
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Wolff
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008408:Mastectomy / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome