title: Applying the neoadjuvant paradigm to ductal carcinoma in situ.
abstract: Local treatment options for ductal carcinoma in situ (DCIS) are virtually identical to those for early invasive breast cancer, despite the fact that the survival from this condition is much higher. Our ability to more appropriately tailor therapy for DCIS is hampered by a lack of understanding of the natural history of DCIS, our limited ability to predict the rate of progression to invasive cancer and the response to therapy, and the absence of tools to follow patients who have not had invasive treatments. Neoadjuvant therapy, which has been proven to be both safe and effective in tailoring treatments for invasive cancer, could be ideally suited to DCIS. However, neoadjuvant therapy requires that doctors and patients delay surgical treatment that has known benefits. In order to successfully introduce this approach into clinical practice, risk assessment and decision support tools will be needed to help physicians and patients feel comfortable that they are not being exposed to unnecessary or excessive risk. In addition, we need better imaging to track extent and progression of disease. Among the possible benefits of the neoadjuvant approach, we may discover that many lesions are responsive and some even reversible, leaving us with treatments that might be tailored to biology and with important clues for breast cancer prevention in high-risk women.
authors.affiliation: Department of Surgery, University of California San Francisco Medical Center, San Francisco, California 94115, USA. laura.esserman@ucsfmedctr.org
authors.forename: Laura
authors.initials: L
authors.lastname: Esserman
authors.forename: Karen
authors.initials: K
authors.lastname: Sepucha
authors.forename: Elissa
authors.initials: E
authors.lastname: Ozanne
authors.forename: E Shelley
authors.initials: ES
authors.lastname: Hwang
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D016861:Cyclooxygenase Inhibitors