NIH state-of-the-science conference statement: diagnosis and management of ductal carcinoma in situ (DCIS).
OBJECTIVE
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the diagnosis and management of ductal carcinoma in situ (DCIS).


METHODS
An non-DHHS, nonadvocate 14-member panel representing the fields of fields of oncology, radiology, surgery (general and reconstructive), pathology, radiation oncology, internal medicine, epidemiology, biostatistics, nursing, obstetrics and gynecology, preventative medicine and population health, and social work. In addition, 22 experts from pertinent fields presented data to the panel and conference audience.


METHODS
Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.


METHODS
The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.


CONCLUSIONS
The diagnosis and management of DCIS is highly complex with many unanswered questions, including the fundamental natural history of untreated disease. Because of the noninvasive nature of DCIS, coupled with its favorable prognosis, strong consideration should be given to remove the anxiety-producing term "carcinoma" from the description of DCIS. The outcomes in women treated with available therapies are excellent. Thus, the primary question for future research must focus on the accurate identification of patient subsets diagnosed with DCIS, including those persons who may be managed with less therapeutic intervention without sacrificing the excellent outcomes presently achieved. Essential in this quest will be the development and validation of accurate risk stratification methods based on a comprehensive understanding of the clinical, radiological, pathological, and biological factors associated with DCIS.
University of Florida Shands Cancer Center, University of Florida, Gainesville, Florida, USA.
Carmen J
CJ
Allegra
Denise R
DR
Aberle
Pamela
P
Ganschow
Stephen M
SM
Hahn
Clara N
CN
Lee
Sandra
S
Millon-Underwood
Malcom C
MC
Pike
Susan D
SD
Reed
Audrey F
AF
Saftlas
Susan A
SA
Scarvalone
Arnold M
AM
Schwartz
Carol
C
Slomski
Greg
G
Yothers
Robin
R
Zon
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008327:Mammography; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D013629:Tamoxifen / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen