Editorial
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World J Clin Oncol. Aug 10, 2014; 5(3): 194-196
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.194
Towards optimal treatment of ductal carcinoma in situ
Christina Choy, Kefah Mokbel
Christina Choy, Kefah Mokbel, The London Breast Institute, The Princess Grace Hospital, London W1U 5NY, United Kingdom
Author contributions: Both authors contributed equally to the article.
Correspondence to: Kefah Mokbel, Lead Breast Surgeon and Professor of Breast Cancer Surgery, The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, United Kingdom. kefahmokbel@hotmail.com
Telephone: +44-207-9082040 Fax: +44-207-9082275
Received: October 14, 2013
Revised: April 28, 2014
Accepted: May 29, 2014
Published online: August 10, 2014
Processing time: 288 Days and 8.5 Hours
Abstract

Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer with a variable biological behavior which is difficult to accurately predict using the current clinico-pathological parameters. Randomized controlled trials have demonstrated that adjuvant radiotherapy (RT) reduces the risk of local recurrence after adequate local excision of DCIS. Tamoxifen may be considered as an adjuvant endocrine treatment in patients with high risk estrogen receptor positive disease. There is however a growing consensus that RT can be safely omitted in a subgroup of patients with favorable biological features in order to avoid overtreatment. The sentinel node biopsy is not routinely indicated but should be considered in women undergoing mastectomy for DCIS. The discovery of molecular signatures that accurately predict the biological behavior of this common malignancy will facilitate a personalized treatment approach in the future.

Keywords: Ductal carcinoma in situ; Treatment; Radiotherapy; Tamoxifen

Core tip: Localized ductal carcinoma in situ (DCIS) is treated with adequate local excision followed by radiotherapy (RT) in most cases whereas extensive disease is treated with mastectomy (± immediate reconstruction). RT may be safely omitted in some patients with adequately excised low risk DCIS.