title: National Institutes of Health State-of-the-Science Conference statement: Diagnosis and Management of Ductal Carcinoma In Situ September 22-24, 2009.
abstract: 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
  A non-Department of Health and Human Services, nonadvocate, 14-member panel representing the 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 National Institutes of Health or the Federal Government.
  
  
  CONCLUSIONS
  Clearly, 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 elimination of the use of 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, pathological, and biological factors associated with DCIS.
authors.affiliation: University of Florida Shands Cancer Center, Department of Medicine, University of Florida, Gainesville, FL 32610, USA. carmen.allegra@medicine.ufl.edu
authors.forename: Carmen J
authors.initials: CJ
authors.lastname: Allegra
authors.forename: Denise R
authors.initials: DR
authors.lastname: Aberle
authors.forename: Pamela
authors.initials: P
authors.lastname: Ganschow
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hahn
authors.forename: Clara N
authors.initials: CN
authors.lastname: Lee
authors.forename: Sandra
authors.initials: S
authors.lastname: Millon-Underwood
authors.forename: Malcolm C
authors.initials: MC
authors.lastname: Pike
authors.forename: Susan D
authors.initials: SD
authors.lastname: Reed
authors.forename: Audrey F
authors.initials: AF
authors.lastname: Saftlas
authors.forename: Susan A
authors.initials: SA
authors.lastname: Scarvalone
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Schwartz
authors.forename: Carol
authors.initials: C
authors.lastname: Slomski
authors.forename: Greg
authors.initials: G
authors.lastname: Yothers
authors.forename: Robin
authors.initials: R
authors.lastname: Zon
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000639:trends; D005260:Female; D006801:Humans; D009316:National Institutes of Health (U.S.); D011379:Prognosis; D011788:Quality of Life; D012196:Review Literature as Topic; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States