What is the treatment for Ductal Carcinoma In Situ (DCIS)?

From the Guidelines

Treatment for ductal carcinoma in situ (DCIS) typically involves surgery, often followed by radiation therapy and sometimes hormonal therapy, with the primary goal of preventing progression to invasive breast carcinoma, as recommended by the most recent guidelines 1. The primary surgical options are breast-conserving surgery (lumpectomy) or mastectomy, with radiation therapy usually recommended after lumpectomy to eliminate any remaining cancer cells and reduce recurrence risk.

• The choice of treatment depends on factors such as the size and grade of the DCIS, patient age, family history, and personal preferences.
• For hormone receptor-positive DCIS, hormonal therapy with tamoxifen or aromatase inhibitors may be prescribed for 5-10 years to further reduce recurrence risk, as supported by previous studies 1.
• Regular follow-up care is essential after treatment, including mammograms and clinical breast exams, to monitor for any signs of recurrence or new breast cancer development.
• The most recent guidelines suggest that moderately hypofractionated treatment schedules are as effective as standard fractionation treatment schedules in management of DCIS, and that the addition of boost lowers recurrence rates in non-low-risk DCIS cases 1.
• Additionally, adjuvant endocrine therapy can further reduce the risk of recurrence in DCIS treated with breast conservation and radiation therapy, as well as prevent contralateral disease, with either tamoxifen or an AI being options 1.

From the FDA Drug Label

The decision regarding therapy with tamoxifen for the reduction in breast cancer incidence should be based upon an individual assessment of the benefits and risks of tamoxifen therapy. In women with DCIS, following breast surgery and radiation, tamoxifen citrate tablets are indicated to reduce the risk of invasive breast cancer The recommended dose is tamoxifen 20 mg daily for 5 years.

The treatment for ductal carcinoma in situ (DCIS) is tamoxifen 20 mg daily for 5 years, following breast surgery and radiation, to reduce the risk of invasive breast cancer 2, 2, 2.

• Key points:
  • Tamoxifen is indicated to reduce the risk of invasive breast cancer in women with DCIS.
  • The recommended dose is 20 mg daily for 5 years.
  • The decision to use tamoxifen should be based on an individual assessment of benefits and risks.

From the Research

Treatment Options for Ductal Carcinoma In Situ

• Standard options for the treatment of ductal carcinoma in situ (DCIS) include breast-conserving surgery (BCS) alone; BCS with radiotherapy or endocrine therapy, or both; and mastectomy 3
• Surgery remains the standard of care for the initial treatment of DCIS, with adjuvant radiation therapy (RT) consistently demonstrating a reduction in the risk of local recurrence following breast-conserving surgery (BCS) 4
• The use of radiotherapy after BCS reduces the rate of ipsilateral local recurrence by about half, and the addition of hormonal therapy reduces the rate of all breast cancer events (ipsilateral plus contralateral) 5

Risk Stratification and Treatment Decision-Making

• Risk stratification using clinical and pathologic characteristics, and more recently molecular profiling, can help guide clinical decision-making for the use of radiation treatment and hormonal therapy 5, 3
• Young age, inadequate margins, and greater volume of disease are associated with higher risk of local recurrence (LR) after BCS, while young age, high grade, and microinvasion are associated with higher risk of locoregional recurrence after mastectomy 3
• Clinical tools, including the Memorial Sloan Kettering Cancer Center (MSKCC) DCIS nomogram, provide LR risk estimates after BCS that appear more accurate than current genomic assays 3

Ongoing Research and Future Directions

• Ongoing studies are evaluating the possibility of de-escalating therapy, and in some studies, even using core biopsy alone, without surgical excision 5
• The safety of active surveillance for seemingly low-risk patients remains uncertain, and estimation of LR risk can help a woman balance that risk with her values and priorities, and allow her to choose the optimal treatment option for her 3
• Future studies are required to identify cohorts of patients in which RT can be safely omitted, as well as to evaluate whether short-course RT alone may represent a better option than endocrine therapy with respect to compliance, toxic effects, cost, and local control following BCS 4