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Ductal Carcinoma In Situ

  • Ian H. KunklerEmail author
Chapter

Abstract

Ductal carcinoma in situ (DCIS) represents a growing health challenge with increasing numbers of cases detected through breast screening programmes. It is unclear exactly what factors contribute to the pathogenesis of DCIS and its progression to invasive cancer. Breaching of the myoepithelial cell layer and basement membrane is a key feature of the progression from DCIS to invasive cancer. It is thought that myoepithelial cells have an active role in tumour suppression by downregulating metalloproteinases. While mammography remains the standard imaging modality for detection of DCIS, MRI has an increasing role in assessing its extent. The absolute mortality of DCIS is extremely low. The primary aim of treatment is to prevent local recurrence, particularly invasive recurrence. However, we lack reliable biomarkers to identify which patients are most likely to recur. Some form of surgery (breast conserving or mastectomy) is recommended virtually for all patients. The role of observation for small low-grade lesions is under investigation. Obtaining clear margins is important to minimising the risk of local recurrence. Adjuvant postoperative radiotherapy roughly halves the rate of DCIS and invasive recurrence. Whether there is a subset of patients from whom radiotherapy can be safely omitted is uncertain but the absolute benefit in small, low-grade lesions is very limited. The role of adjuvant hormonal therapy in DCIS is not well established. The principal benefit of adjuvant tamoxifen is the reduction in the risk of contralateral non-invasive disease. This chapter focuses on level 1 evidence as a guide to treatment.

Keywords

Ductal carcinoma in situ Breast cancer Breast conservation Breast cancer biology Radiation Radiotherapy 

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Institute of Genetics and Molecular Medicine (IGMM)University of EdinburghEdinburgh, ScotlandUK

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