The management of ductal carcinoma in situ: current controversies and future directions.

The incidence of ductal carcinoma in situ (DCIS) has increased in recent decades, primarily due to the widespread implementation of breast cancer screening. Traditionally, the management of DCIS has mirrored that of invasive breast cancer, with a focus on adequate surgical excision, breast-conserving surgery, adjuvant radiotherapy and endocrine therapy. However, an increasing understanding of the biology of this spectrum of conditions many mean that some cases may be managed more conservatively, reserving aggressive therapies for those patients at high risk of progression to invasive disease, ultimately aiming for a personalised approach based on individual risk factors. This overview highlights the key evidence behind current practice and discusses the rationale for current and future clinical trials in DCIS.