title: Current treatment trends and the need for better predictive tools in the management of ductal carcinoma in situ of the breast.
abstract: Ductal carcinoma in situ (DCIS) of the breast represents a group of heterogeneous non-invasive lesions the incidence of which has risen dramatically since the advent of mammography screening. In this review we summarise current treatment trends and up-to-date results from clinical trials studying surgery and adjuvant therapy alternatives, including the recent consensus on excision margin width and its role in decision-making for post-excision radiotherapy. The main challenge in the clinical management of DCIS continues to be the tailoring of treatment to individual risk, in order to avoid the over-treatment of low-risk lesions or under-treatment of DCIS with higher risk of recurring or progressing into invasion. While studies estimate that only about 40% of DCIS would become invasive if untreated, heterogeneity and complex natural history have prevented adequate identification of these higher-risk lesions. Here we discuss attempts to develop prognostic tools for the risk stratification of DCIS lesions and their limitations. Early results of a UK-wide audit of DCIS management (the Sloane Project) have also demonstrated a lack of consistency in treatment. In this review we offer up-to-date perspectives on current treatment and prediction of DCIS, highlighting the pressing clinical need for better prognostic indices. Tools integrating both clinical and histopathological factors together with molecular biomarkers may hold potential for adequate stratification of DCIS according to risk. This could help develop standardised practices for optimal management of patients with DCIS, improving clinical outcomes while providing only the amount of therapy required for each individual patient.
authors.affiliation: Breast Cancer Now Edinburgh Research Team, Western General Hospital, University of Edinburgh, United Kingdom. Electronic address: carlos.martinez-perez@igmm.ed.ac.uk.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martínez-Pérez
authors.affiliation: Breast Cancer Now Edinburgh Research Team, Western General Hospital, University of Edinburgh, United Kingdom.
authors.forename: Arran K
authors.initials: AK
authors.lastname: Turnbull
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, University of Edinburgh, United Kingdom.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Ekatah
authors.affiliation: Breast Cancer Now Edinburgh Research Team, Western General Hospital, University of Edinburgh, United Kingdom.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Arthur
authors.affiliation: Breast Cancer Now Edinburgh Research Team, Western General Hospital, University of Edinburgh, United Kingdom.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Sims
authors.affiliation: Department of Pathology, Western General Hospital, Edinburgh, United Kingdom.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Thomas
authors.affiliation: Edinburgh Breast Unit, Western General Hospital, University of Edinburgh, United Kingdom.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dixon
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D058990:Molecular Targeted Therapy; D049451:Nomograms; D011237:Predictive Value of Tests; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment / Q000379:methods
chemical_list: D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor
keywords: Breast cancer; DCIS; Ductal carcinoma in situ; Patient stratification; Prognostic tools; Risk prediction