The treatment of ductal carcinoma in situ of the breast

As screening mammography has become more frequently used to screen asymptomatic women, the diagnosis of ductal carcinoma in situ (DCIS) has become commonplace. Its treatment remains contentious, ranging from mastectomy to local excision alone. The goal of treatment for DCIS is breast conservation, however, as many as 25% of women with this diagnosis may require mastectomy. Although no clear selection criteria have been adopted to subdivide patients into groups best treated by either mastectomy or local excision with or without radiation therapy, many patients with DCIS are candidates for local excision alone, if the biology of the disease is favorable, the size is small, and the margins are negative. Radiation therapy added to local excision decreases the likelihood of recurrence; however, if there is recurrence when first radiation is employed, the patient's only remaining choice often is mastectomy.