De-escalation in DCIS Care

Purpose of ReviewStandard DCIS management consists of surgery with consideration of adjuvant radiation and endocrine therapy. However, widespread recognition of the overdiagnosis and overtreatment burden in DCIS has led to a reevaluation of this standard. The purpose of this review is to summarize the foundational clinical trials in DCIS and to discuss ongoing efforts in treatment de-escalation.Recent FindingsStandard of care DCIS management is based on large high-quality randomized clinical trials. The results of those trials have been durable over more than a decade of follow-up. However, we now better appreciate that DCIS is a heterogeneous disease with variable risk of progression. Clinicopathologic and molecular tools are helping better define which patients with DCIS would benefit from de-escalation. Modern clinical trials have proven the safety of shorter and lower dose radiation regimens in low-risk patients, and results from active monitoring trials are highly anticipated. In addition, decision support tools, shared decision-making, and molecular testing promise to help guide patients through an increasingly complex decision-making process.Current treatment of DCIS has moved towards successful de-escalation of treatment for those patients with low risk of progression. Further incorporation of molecular tools will allow for personalized treatment based on individual risk and preferences.