title: Ductal carcinoma in situ: a review of recent advances.
abstract: OBJECTIVE
  This review summarizes recent findings on ductal carcinoma in situ of the breast and their impact on prognosis and management of the disease.
  
  
  RESULTS
  Great advances have been made in our understanding of ductal carcinoma in situ. Nuclear grading is probably the most important pathological factor that affects clinical outcome and correlates with distinct genetic pathways. Identifying key molecules in each pathway may provide better markers for prognostic, predictive and therapeutic purposes. Not all cases of ductal carcinoma in situ will progress to invasive ductal carcinoma, and identifying this subgroup of patients should lead to a reduction of overtreatment. Progenitor cell theory at the cellular level and sick lobe theory at the architectural level may help provide a better understanding of ductal carcinoma in situ from a different perspective and facilitate the development of individualized therapy. Prevention of local recurrence is the primary goal for treatment. Debate continues, however, on the use of radiotherapy, hormonal therapy, and sentinel lymph node biopsy. A panel of molecular markers may be needed for accurately predicting clinical outcome for the disease.
  
  
  CONCLUSIONS
  Understanding the carcinogenesis of ductal carcinoma in situ at the molecular level may lead to an optimal individualized therapy with minimal over or undertreatment.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA. ping_tang@urmc.rochester.edu
authors.forename: Ping
authors.initials: P
authors.lastname: Tang
authors.forename: Steven I
authors.initials: SI
authors.lastname: Hajdu
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D015415:Biomarkers; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011379:Prognosis
chemical_list: D015415:Biomarkers