From the Guidelines
The standard of care for Ductal Carcinoma In Situ (DCIS) involves surgical excision, with options including breast-conserving surgery (lumpectomy) or mastectomy, often followed by radiation therapy and sometimes hormonal therapy, as recommended by the most recent guidelines 1. The treatment approach is individualized based on the patient's age, DCIS characteristics (size, grade, hormone receptor status), and personal preferences.
- Surgery options include:
- Lumpectomy plus whole breast radiation therapy (WBRT) with or without boost
- Total mastectomy, with or without sentinel lymph node biopsy (SLNB) and optional reconstruction
- Lumpectomy alone, which should be considered only in cases with low risk of disease recurrence Key considerations in treatment decisions include:
- The extent of DCIS in the breast
- Breast size
- Patient preference
- Hormone receptor status
- The presence of comedonecrosis or other factors associated with increased risk of recurrence Radiation therapy after breast-conserving surgery reduces the recurrence risk of DCIS or invasive breast cancer in the ipsilateral breast, with moderately hypofractionated treatment schedules being as effective as standard fractionation treatment schedules 1. For hormone receptor-positive DCIS, adjuvant endocrine therapy with tamoxifen or an aromatase inhibitor can further reduce the risk of recurrence and prevent contralateral disease 1. Regular follow-up with clinical breast exams and mammography is essential after treatment to monitor for recurrence or progression to invasive breast cancer.
From the FDA Drug Label
Ductal Carcinoma in Situ (DCIS) 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 standard of care for DCIS includes breast surgery and radiation, followed by tamoxifen 20 mg daily for 5 years to reduce the risk of invasive breast cancer 2 2.
From the Research
Standard of Care for DCIS
The standard of care for Ductal Carcinoma In Situ (DCIS) typically involves a combination of treatments, including:
- Breast-conserving surgery (lumpectomy) followed by radiation therapy 3, 4
- Mastectomy, which may be indicated for larger or more diffuse lesions, or for patients with persistent margin involvement 4
- Hormonal therapy, such as tamoxifen, which may be considered for patients with estrogen receptor-positive (ER+) DCIS or those who undergo excision alone 5
Treatment Options
Treatment options for DCIS include:
- Breast-conserving surgery (BCS) with radiation therapy, which reduces the risk of local recurrence by about half 3
- BCS alone, which may be considered for patients with small, low-grade lesions and clear margins 4
- Mastectomy, which is indicated for patients with larger or more diffuse lesions, or for those with persistent margin involvement 4
- Nipple-sparing mastectomy (NSM), which may be considered for patients who are not candidates for breast-conserving therapy 6
Risk Stratification
Risk stratification is important in determining the best course of treatment for DCIS. Factors that influence risk stratification include:
- Tumor size and grade 3, 4
- Presence of comedonecrosis 6
- Estrogen receptor status 5
- Margin status 4
- Patient age and overall health 5
Adjuvant Therapy
Adjuvant therapy, such as radiation therapy and hormonal therapy, may be considered for patients with DCIS. The use of adjuvant therapy is influenced by factors such as tumor size and grade, estrogen receptor status, and margin status 3, 4, 5, 7