title: Ductal carcinoma in situ: recent history and areas of controversy.
abstract: The authors provide a perspective on the rapidly evolving field of prognostic analyses designed to quantify the risk of local recurrence in conservatively treated ductal carcinoma in situ (DCIS). These include morphologic features variously defined, nomograms, algorithms and multi-gene expression assays-all of which have completed against the perceived conclusions of the randomized trials of irradiation and Tamoxifen for DCIS: "all subsets benefit". At present the majority of newly diagnosed DCIS can be adequately treated with surgery alone. A number will require irradiation to achieve acceptable local control, and a minority will require mastectomy regardless of adjuvant treatments. Differences in the definition of prognostic factors and in the methods used to establish them is a major reason for the lack of consensus in treatment recommendation.
authors.affiliation: Breast Cancer Consultation Service, Tiburon, California.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Lagios
authors.forename: Melvin J
authors.initials: MJ
authors.lastname: Silverstein
mesh_terms: D000465:Algorithms; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000235:genetics / Q000266:history* / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000235:genetics / Q000266:history* / Q000628:therapy; D005260:Female; D049674:History, 21st Century; D006801:Humans; D049451:Nomograms; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013629:Tamoxifen / Q000627:therapeutic use; D059467:Transcriptome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
keywords: DCIS; breast conservation; local control; radiation therapy; tamoxifen