Similarly, SLNB should be performed if the lumpectomy will compromise drainage enough to prevent a future sentinel lymph node procedure. This is most often considered for DCIS lesions located in the high axillary tail. It is extremely difficult to trace the natural history of DCIS. As in the last decades the rate of invasive recurrence of DCIS has not changed significatively, despite an increased rate of diagnoses basedon mammographic screening, it is likely that the majority of patients with DCIS does notdevelop invasive carcinoma.
This concept is in line with what we know from carcinomas in situ occurring in other organs. We can speculate about the natural history of DCIS by evaluating the clinco-pathological studies based on the recurrence rate after a histologicallyproven diagnosis on core biopsy. Notably only The most updated view about DCIS considers this disease as a wide morphological and biological spectrum, ranging from small-sized, usually low-grade, lesions that can be treated by surgical excision alone, to extensive, often high-grade lesions, for which the best treatment seems to be mastectomy.
Based on the notions from the natural history of DCIS, patients with a histologically proven diagnosis should be treated to prevent the possibility of local recurrence both in terms of non-invasive or invasive carcinoma. Over time, there have been many efforts to identify patients with low- or high-risk DCIS lesions, in order to avoid, respectively, over- or under-treatment.
The option of an active surveillance could be offered not only to older patients, but also to all patients with mortality risks due to other diseases [ 42 ]. As far as surgery is concerned, mastectomy, with immediate or subsequent breast reconstruction, is strongly recommended for those patients with large-sized tumors, multifocal tumors, small-sized breasts cosmetic problems , family history, or documented BRCA mutations.
Conversely, the proposal of BCS alone or in combination with radiotherapy is still a matter of debate. Tamoxifen may be more efficacious in patients receiving concurrent adjuvant radiotherapy. We wish to thank the Scientific Bureau of the University of Catania for language support. Conceptualization, L. All authors have read and agreed to the published version of the manuscript.
National Center for Biotechnology Information , U. Journal List Cancers Basel v. Cancers Basel. Published online Mar 6. Find articles by Lucia Salvatorelli. Find articles by Lidia Puzzo. Find articles by Giada Maria Vecchio. Find articles by Rosario Caltabiano.
Find articles by Gaetano Magro. Author information Article notes Copyright and License information Disclaimer. Received Feb 9; Accepted Mar 2. This article has been cited by other articles in PMC. Keywords: DCIS, diagnosis, mammography, morphological features, immunohistochemical profile, prognosis. Open in a separate window. Figure 1. Figure 2. Figure 3. Morphological Features of Carcinoma In Situ DCIS is a unifocal disease originally restricted to a single duct system but with the capability to involve different lobules.
Figure 4. Immunohistochemical Profile Although several immunohistochemical studies have been performed on DCIS, with the aim of correlating a specific immunohistochemical profile with the risk of local recurrence in terms of in situor invasive lesions , the results are conflicting [ 16 ]. Molecular Features Breast cancer does not yet have a molecular signature that can predict the risk of recurrence or that may indicate treatment.
Sentinel Node Sampling DCIS is—by definition—a carcinoma without invasion of the basement membrane and thus the examination of axillary nodes is indicated only for selected patients. Treatment Based on the notions from the natural history of DCIS, patients with a histologically proven diagnosis should be treated to prevent the possibility of local recurrence both in terms of non-invasive or invasive carcinoma.
Acknowledgments We wish to thank the Scientific Bureau of the University of Catania for language support. Author Contributions Conceptualization, L. Funding This research received no external funding. Conflicts of Interest The authors declare no conflict of interest. References 1. Classification of Breast Tumours. Weaver D. Pathologic findings from the Breast Cancer SurvellainceConsortium: Vpopulation-based outcomes in women undergoing biopsy after screening mammography. Siegel R.
Cancer statistics, CA Cancer J. Levinsohn E. Controversies regarding the diagnosis and management of ductal carcinoma in situ. Other studies have tried to quantify the thickness of the subcutaneous tissue layer of the breast, but this is difficult to measure accurately, since tissue processing techniques are variable.
Financial Disclosure: The authors have no significant financial interest in or other relationship with the manufacturer of any product or provider of any service mentioned in this article. If you have a case that you feel has particular educational value, illustrating important points in diagnosis or treatment, you may send the concept to Dr.
Crawford at david. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst.
The locoregional recurrence post-mastectomy for ductal carcinoma in situ: incidence and risk factors. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. Molecular phenotypes of DCIS predict overall and invasive recurrence. Ann Oncol. Pilewskie M, Morrow M. Axillary nodal management following neoadjuvant chemotherapy: a review. Lancet Oncol. Oncology Williston Park. Breast Cancer Res Treat.
Determinants of optimal mastectomy skin flap thickness. DCIS is diagnosed by a needle biopsy. Pathologists examine the abnormal cells to determine the grade of the DCIS and the hormone-receptor status.
DCIS is classified as low, intermediate, or high grade, depending on how abnormal the cells look under a microscope. High-grade DCIS cells are the most abnormal and grow the fastest. Hormone-receptor status refers to whether the cancer cells have receptors for estrogen, progesterone, or both. The presence of these receptors on the DCIS suggests that these hormones fuel the growth of the cells, which affects how well the DCIS responds to certain hormone-blocking drugs.
A person diagnosed with DCIS usually meets with a breast surgeon first. For example, should a patient get genetic testing for inherited mutations such as BRCA1 or BRCA2 , which are known to raise risk for future breast cancer? Do they have a strong family history of the disease? Surgery is typically the first treatment for DCIS, and it is very effective. There are two types of surgery used for DCIS.
This can be done at the same time as your mastectomy immediate reconstruction or months or years later delayed reconstruction. Some women choose not to or cannot have a breast reconstruction. They may use a breast prosthesis or may prefer not to use anything.
Lymph node removal is not usually recommended for people with DCIS. Sentinel lymph node biopsy identifies whether the sentinel lymph node the first lymph node that the cancer cells are most likely to spread to is clear of cancer cells. There may be more than one sentinel lymph node. If clear, this usually means the other nodes are clear too, so no more will need to be removed.
If the results of the sentinel lymph node biopsy show that the first node or nodes are affected, then this may mean there is an invasive breast cancer as well as DCIS.
Occasionally, small areas of invasive cancer may be missed during the initial biopsy. After surgery, you may need other treatments. These are called adjuvant treatments and can include radiotherapy and, in some cases, hormone therapy. The aim of these treatments is to reduce the risk of DCIS coming back or an invasive cancer developing. Chemotherapy and targeted biological therapy are not used as treatment for DCIS.
Radiotherapy uses high energy x-rays to destroy cancer cells. It is not usually necessary to have radiotherapy after a mastectomy for DCIS. Radiotherapy is usually given for a total of three weeks. Treatment is given every day from Monday to Friday, with a break at the weekend.
Your treatment team will let you know how long your radiotherapy will last. They will explain the likely benefits of radiotherapy for you and also tell you about any possible side effects. Some breast cancers use oestrogen in the body to help them to grow. Hormone therapies block or stop the effect of oestrogen on breast cancer cells.
Different hormone therapy drugs do this in different ways. Some studies have found taking hormone therapy after surgery reduces the risk of DCIS coming back recurrence and the risk of invasive breast cancer developing.
Progesterone is another hormone. Very few breast cancers fall into this category. However, if this is the case your specialist will discuss with you whether hormone therapy is appropriate. Being told you have DCIS can be a difficult and worrying time. Everyone reacts differently to their diagnosis and have their own way of coping. Although DCIS is an early form of breast cancer with a very good prognosis, people understandably may feel very anxious and frightened by the diagnosis. People can often struggle to come to terms with being offered treatments such as a mastectomy, at the same time as being told their DCIS may never do them any harm.
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