[Ductal carcinoma in situ in 2019: Diagnosis, treatment, prognosis]

Presse Med. 2019 Oct;48(10):1112-1122. doi: 10.1016/j.lpm.2019.08.018. Epub 2019 Oct 22.
[Article in French]

Abstract

Ductal carcinoma in situ (DCIS) currently represents up to 15% of the newly diagnosed breast cancers, and are almost always detected by microcalcifications. Global prognosis is good (3% of 15-year specific mortality) but invasive local recurrences (LR) can lead to metastasis in 12-15% of the cases. Breast conserving surgery with whole breast irradiation is the main treatment (reducing LR by 50%), but mastectomy (with or without reconstruction) is performed in about 30% of the cases due to wide lesion size and/or multicentricity. The role of tamoxifen remains unclear. Axillary dissection is needless but sentinel node biopsy is proposed in case of micro-invasion suspicion (large lesions with high grade). The main factors of LR are young age (≤40 years) incomplete excision, and high nuclear grade with comedonecrosis. Several studies on "therapeutic descalation" are still ongoing in order to identify the "low risk" DCIS (about 10% of the cases) in which radiotherapy could be safely omitted.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Biopsy
  • Breast / pathology
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / etiology
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy*
  • Carcinoma, Intraductal, Noninfiltrating / diagnosis*
  • Carcinoma, Intraductal, Noninfiltrating / etiology
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Carcinoma, Intraductal, Noninfiltrating / therapy*
  • Combined Modality Therapy / methods
  • Conservative Treatment
  • Diagnostic Imaging / methods
  • Female
  • Humans
  • Lymph Node Excision / trends
  • Mastectomy
  • Neoplasm Recurrence, Local / diagnosis
  • Prognosis
  • Radiotherapy
  • Risk Factors
  • Tamoxifen / therapeutic use
  • Time Factors

Substances

  • Antineoplastic Agents, Hormonal
  • Tamoxifen