Treatment of ductal carcinoma in situ of the breast

Ductal carcinoma in situ (DCIS) is increasing in frequency, primarily because of the increasing use of routine screening mammography. The management of DCIS has become one of the more controversial aspects in the treatment of breast cancer. Although total mastectomy provides local control and long-term survival approaching 100%, the move to breast conservation with early invasive breast cancer has forced a re-evaluation of the treatment of in situ breast cancer. Recent advances in the evaluation and subclassification of DCIS according to histologic subgroupings and sizings have provided valuable insight into the biology of the disease. These biologic parameters may help to identify those lesions amenable to breast conservation. In properly selected patients, breast conservation affords a 1%/year local failure rate, with approximately one-half of the recurrences being invasive.