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Breast Disease pp 115-123 | Cite as

Ductal Carcinoma In Situ

  • Priscilla McAuliffeEmail author
Chapter

Abstract

Ductal carcinoma in situ (DCIS) is defined as abnormally proliferating malignant cells confined to the breast milk ducts by the basement membrane. The prognosis of DCIS with microinvasion (DCISM) is intermediate between DCIS and invasive ductal cancer. DCIS is diagnosed most commonly as a mammographic abnormality but can occasionally present as a palpable breast mass. Therapy for DCIS is personalized for each patient, based on tumor-to-breast size ratio, mammographic appearance, margin width, and patient preference. The benefits and risks of breast-conserving therapy versus mastectomy should be discussed in detail. Overall survival after breast-conserving therapy is equivalent to mastectomy. Re-excision is recommended for positive margins and, while debated, pathologic margins less than 2 mm. For breast conservation therapy, radiation therapy is recommended to reduce the risk of local recurrence. Mastectomy is indicated in patients with persistently positive margins after attempts at breast conservation, in those with a contraindication to radiation therapy, and in patients with diffuse, malignant-appearing calcifications or if a patient’s anxiety about local recurrence outweighs the impact of a mastectomy on quality of life. Patients undergoing mastectomy for DCIS should have sentinel lymph node biopsy. Immediate breast reconstruction should be considered for patients undergoing mastectomy. Endocrine therapy such as tamoxifen is offered for 5 years to women with estrogen receptor-positive DCIS. Patients with DCIS should have annual clinical breast exams and annual mammographic imaging of all remaining breast tissue.

Keywords

Ductal carcinoma in situ DCIS Microinvasion NSABP B-24 IBIS NSABP B-17 NSABP B-35 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Surgery, Division of Surgical OncologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Magee-Women’s Surgical AssociatesPittsburghUSA
  3. 3.Women’s Cancer Research Center of UPMC Hillman Cancer CenterPittsburghUSA

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