[When will we stop mastectomies for intraductal carcinoma?]

Area of Science:

• Oncology
• Breast Surgery
• Pathology

Background:

• Growing interest in breast ductal carcinoma in situ (DCIS) due to increasing incidence and diagnostic difficulties.
• Natural history of DCIS is unpredictable, with uncertainty regarding progression to invasive carcinoma.
• Treatment controversies stem from the inability to accurately predict which DCIS will become invasive.

Purpose of the Study:

• To critically review current literature on conservative treatment options for DCIS.
• To evaluate the risks and benefits of conservative management versus mastectomy for DCIS.
• To discuss factors influencing treatment decisions and outcomes for DCIS.

Main Methods:

• Critical review of recent scientific publications on DCIS diagnosis and treatment.
• Analysis of data regarding local recurrence rates and survival outcomes for different treatment modalities.
• Examination of ongoing randomized trials addressing DCIS management.

Main Results:

• Conservative treatment for DCIS carries a risk of local recurrence, with approximately half of recurrences developing into invasive patterns.
• Total mastectomy offers high survival rates (nearly 100% at 10 years), but conservative approaches are being investigated.
• Conservative treatment, including wide surgical excision and external irradiation, may be suitable for small, low-grade DCIS with rigorous follow-up.

Conclusions:

• Conservative management of DCIS is a viable option for specific patient groups, particularly small, low-grade lesions.
• The potential for increased mortality with conservative strategies needs careful consideration against breast conservation benefits.
• Surgical excision alone for DCIS should be limited to clinical trials or very small lesions identified post-resection.