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

From the Guidelines

The treatment for Ductal Carcinoma In Situ (DCIS) after biopsy typically involves surgical removal of the abnormal tissue, often followed by radiation therapy and sometimes hormonal therapy, with the primary surgical options being breast-conserving surgery (lumpectomy) or mastectomy, depending on factors such as the size and extent of the DCIS, breast size, and patient preference. The choice of treatment is individualized based on the patient's age, overall health, DCIS characteristics (size, grade, hormone receptor status), and personal preferences 1. After lumpectomy, radiation therapy is usually recommended to reduce the risk of recurrence, with a standard course involving daily treatments for 3-6 weeks 1. For hormone receptor-positive DCIS, hormonal therapy with tamoxifen (20mg daily for 5-10 years) or aromatase inhibitors like anastrozole (1mg daily for 5 years) may be prescribed to further reduce recurrence risk 1. Some key points to consider in the treatment of DCIS include:

• The goal of primary therapy for DCIS is to prevent progression to invasive breast carcinoma 1
• The addition of whole-breast radiation therapy (WBRT) after lumpectomy decreases the rate of in-breast disease 1
• Tamoxifen may be considered as a strategy to reduce the risk of ipsilateral breast cancer recurrence in women with DCIS treated with breast-conserving therapy, especially in those with ER-positive DCIS 1
• The treatment choice is individualized based on the patient's age, overall health, DCIS characteristics, and personal preferences 1
• DCIS is considered a pre-invasive or stage 0 breast cancer with excellent prognosis when properly treated, as it has not yet developed the ability to spread beyond the breast ducts to other parts of the body 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. The recommended dose is tamoxifen 20 mg daily for 5 years. In women with DCIS, following breast surgery and radiation, tamoxifen citrate tablets are indicated to reduce the risk of invasive breast cancer

The treatment for Ductal Carcinoma In Situ (DCIS) after biopsy 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:
  • The treatment should be based on an individual assessment of the benefits and risks of tamoxifen therapy.
  • The recommended dose is 20 mg daily for 5 years.
  • Tamoxifen is indicated to reduce the risk of invasive breast cancer in women with DCIS, following breast surgery and radiation.

From the Research

Treatment Options for DCIS after Biopsy

The treatment for Ductal Carcinoma In Situ (DCIS) after biopsy can vary depending on several factors, including the size and grade of the tumor, as well as the patient's overall health and preferences. Some common treatment options include:

• Mastectomy: This involves the removal of the entire breast and is often recommended for patients with large or diffuse tumors, or those with a high risk of recurrence 3.
• Breast-Conserving Surgery (BCS): This involves the removal of the tumor and a small margin of surrounding tissue, and is often followed by radiation therapy to reduce the risk of recurrence 3, 4.
• Radiation Therapy: This involves the use of high-energy rays to kill any remaining cancer cells in the breast, and is often used in combination with BCS 3, 4, 5.
• Tamoxifen: This is a hormone therapy that can be used to reduce the risk of recurrence in patients with hormone receptor-positive DCIS 4, 6.
• Active Surveillance: This involves closely monitoring the patient's condition with regular mammograms and clinical exams, rather than immediately treating the DCIS 4.

Factors Influencing Treatment Choice

The choice of treatment for DCIS after biopsy depends on several factors, including:

• Tumor size and grade: Larger or higher-grade tumors may require more aggressive treatment, such as mastectomy or radiation therapy 3, 4.
• Patient age and overall health: Older patients or those with underlying health conditions may be more likely to undergo less invasive treatments, such as BCS or active surveillance 4.
• Hormone receptor status: Patients with hormone receptor-positive DCIS may be more likely to benefit from tamoxifen therapy 4, 6.
• Patient preferences: Patients may have strong preferences for certain types of treatment, such as BCS or mastectomy, which can influence the treatment choice 3, 4.

Outcomes and Survival

The outcomes and survival rates for patients with DCIS after biopsy vary depending on the treatment chosen and other factors. Studies have shown that:

• Radiation therapy after BCS can reduce the risk of local recurrence and improve survival rates 5.
• Tamoxifen therapy can reduce the risk of recurrence in patients with hormone receptor-positive DCIS 6.
• Mastectomy can be an effective treatment option for patients with large or diffuse tumors, or those with a high risk of recurrence 3, 4.