[New therapeutic perspectives in breast ductal carcinoma in situ]

Management of ductal carcinoma in situ (DCIS) of the breast has suffered from a lack of consensus. The results of recent studies may create the basis for a more rational treatment strategy. Surgical treatment of DCIS with mastectomy is curative, but often unnecessary. Excision, in contrast, carries a recurrence risk of 10-63%, and the recurrence is invasive in half the patients. Two large studies have shown that irradiation after breast conservation reduces the recurrence risk to almost half. Thus, adjuvant radiotherapy should, in principle, be offered. Retrospective analyses indicate, however, that patients having tumours removed with a > 10 mm free margin or with small, low-grade tumours may be considered to be adequately treated by surgery alone. A recent study showed that adjuvant antihormone therapy further reduces the risk of recurrence. The absolute benefit seems low, however, and additional investigations are required.