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In situ breast cancer
R S Henry-Tillman1, V S Klimberg
1Department of Surgery, Division of Breast Surgical Oncology, University of Arkansas for Medical Sciences, John L McClellan Veterans' Administration Hospital, 4301 West Markham, Slot 725, Little Rock, AR, 72205, USA.
Current Treatment Options in Oncology
|June 12, 2002
Summary
Lobular carcinoma in situ (LCIS) management is patient-directed with close follow-up. Ductal carcinoma in situ (DCIS) treatment involves mastectomy or breast conservation therapy, with outcomes dependent on achieving negative margins.
Area of Science:
- Oncology
- Breast Cancer Research
- Surgical Oncology
Background:
- In situ breast cancers, including lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS), often present with subtle or occult clinical signs.
- Minimally invasive diagnostic techniques are crucial for identifying these early-stage breast malignancies.
Purpose of the Study:
- To review current management strategies for LCIS and DCIS.
- To discuss treatment options, focusing on the efficacy and indications for mastectomy versus breast conservation therapy (BCT) for DCIS.
- To highlight the role of tamoxifen in risk reduction for patients with LCIS or a history of DCIS.
Main Methods:
- Review of clinical management guidelines and treatment outcomes for in situ breast cancers.
- Analysis of factors influencing treatment decisions for DCIS, particularly margin status.
- Evaluation of chemoprevention options for patients at risk.
Main Results:
- LCIS management is typically conservative, emphasizing patient choice and close monitoring.
- Mastectomy remains a gold standard for DCIS with low recurrence, while BCT is viable if negative margins are achievable.
- Achieving negative margins is critical for successful BCT in DCIS, necessitating meticulous surgical technique and follow-up.
Conclusions:
- Treatment decisions for DCIS should prioritize achieving negative margins, whether opting for mastectomy or BCT.
- Long-term, close postoperative follow-up is essential for patients undergoing BCT for DCIS.
- Tamoxifen is a valuable option for risk reduction in patients with LCIS or a history of DCIS, requiring careful discussion of risks and benefits.