The optimal management of ductal carcinoma in situ (DCIS) of the breast is one of the greatest challenges in breast disease faced by clinicians today. A decade ago, DCIS was an infrequently seen and poorly understood form of breast cancer; today, it is an important disease entity that has now been estimated to comprise 20 to 40 of all mammogram-directed biopsies.6,66,68,72 The National Cancer Database reports that DCIS comprised 7 of all newly diagnosed breast cancers in 1985; a decade later, this number had doubled to 14,7 and this trend is expected to continue. Much of the observed increase in the incidence of DCIS can be attributed to the widespread availability of mammographic screening,20,21 but greater awareness and knowledge of this disease have also been factors contributing to its more frequent detection. The implementation of mammographic screening has become a national health priority since the first studies demonstrated that mammographic screening decreased the rate of mortality from breast cancer.55 Widespread screening has greatly increased the detection of early preclinical lesions, presenting both a problem and an opportunity. The problem is that it remains unclear which DCIS lesions will progress to invasive disease; therefore, many women are treated aggressively in an effort to prevent invasive cancer or metastatic disease whichever may never have developed. The opportunity lies in a chance to improve the understanding of the factors that affect progression, thereby learning how to treat all early breast cancers of uncertain invasive potential more appropriately and to design more biologically founded therapies. Confusion surrounding the optimal treatment of DCIS continues. Ductal carcinoma in situ is not life-threatening per se unless it progresses to invasive cancer. DCIS may, however, be treated even more aggressively (i.e., with mastectomy) than might be recommended for invasive cancers. In fact, from 1985 to 1992, the mastectomy rate for breast cancer increased largely because it was the primary treatment for women with DCIS.20 The use of breast-conserving treatment for infiltrating carcinomas of the breast has become well-established, but a similar body of knowledge is only now being gathered for DCIS. Thus, the roles of lumpectomy, adjuvant radiation, and chemoprevention in the treatment algorithm for DCIS are only beginning to be understood. There is a growing body of research in molecular markers for DCIS, and the incorporation of such data into clinical decision making will be one of the challenges entering the next decade.

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   |clé=     ISTEX:9C493C362C457DA6DFE98E75AD82CC3B82878799
   |texte=   MANAGEMENT OF DUCTAL CARCINOMA IN SITU
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