Management of ductal carcinoma in situ.

The management of ductal carcinoma in situ (DCIS) is one of the most controversial topics in the treatment of breast cancer. With the introduction and utilization of screening mammography, clinically occult or microscopic DCIS has become the most frequent presentation of this disease. Recent advances in the characterization of DCIS according to histologic subgroupings, size and extent of disease, and nuclear grade have provided important information regarding the natural history of this heterogeneous group of lesions. Critical issues such as multicentricity, occult invasion, and potential for local recurrence and axillary metastases have been addressed in recent series. Prospective, single institution trials and data from the National Surgical Adjuvant Breast and Bowel Project (NSABP-B17) protocol have demonstrated that in many patients with mammographically detected DCIS, mastectomy may be over-treatment. Treatment issues for DCIS now focus on the clinical selection process to identify patients best suited for wide local excision alone vs. wide local excision and breast irradiation.